1912371063 NPI number — HOPE SPRINGS HEALTH LLC

Table of content: (NPI 1912371063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912371063 NPI number — HOPE SPRINGS HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE SPRINGS HEALTH LLC
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:
1912371063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 458
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLIDE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-496-0298
Provider Business Mailing Address Fax Number:
541-496-0703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20172 NORTH UMPQUA HWY.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLIDE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-496-0298
Provider Business Practice Location Address Fax Number:
541-496-0703
Provider Enumeration Date:
11/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAMEWOOD
Authorized Official First Name:
TONI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER/PRACTITIONER
Authorized Official Telephone Number:
541-643-1638

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500697442 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".