Provider Demographics
NPI:1265581144
Name:ST HOPE FOUNDATION INC
Entity type:Organization
Organization Name:ST HOPE FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:GOODIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-778-1300
Mailing Address - Street 1:6200 SAVOY DRIVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3338
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:1414 S FRAZIER ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-4453
Practice Address - Country:US
Practice Address - Phone:936-441-2440
Practice Address - Fax:800-249-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1567299-03Medicaid
TX0021KKOtherBLUE CROSS/BLUE SHIELD
TX0021KKOtherBLUE CROSS/BLUE SHIELD
TX00791XMedicare PIN