Provider Demographics
NPI:1942337183
Name:HOPE FAMILY HEALTH SERVICES
Entity Type:Organization
Organization Name:HOPE FAMILY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:G
Authorized Official - Last Name:DITTES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-644-2000
Mailing Address - Street 1:12124 HIGHWAY 52 W
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-5063
Mailing Address - Country:US
Mailing Address - Phone:615-644-2000
Mailing Address - Fax:615-644-2078
Practice Address - Street 1:1124 NEW HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-5060
Practice Address - Country:US
Practice Address - Phone:615-644-2000
Practice Address - Fax:615-644-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 261QM1300X, 261QR0200X, 363A00000X, 363LP0808X
TN261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728716Medicaid
R32022Medicare UPIN
TN3728716Medicaid