1063625515 NPI number — HOPEWELL CENTER

Table of content: (NPI 1063625515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063625515 NPI number — HOPEWELL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPEWELL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063625515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 GREENSHIRE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63368-8364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-379-7727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 N NEWSTEAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63115-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-531-1770
Provider Business Practice Location Address Fax Number:
314-381-6796
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CASE MANAGER
Authorized Official Telephone Number:
314-531-1770

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  36874 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36874 . This is a "R.N." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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