Provider Demographics
NPI:1154562544
Name:HOPEWELL
Entity type:Organization
Organization Name:HOPEWELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-426-2000
Mailing Address - Street 1:9637 STATE ROUTE 534
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062
Mailing Address - Country:US
Mailing Address - Phone:440-426-2000
Mailing Address - Fax:440-426-2002
Practice Address - Street 1:9637 STATE ROUTE 534
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9516
Practice Address - Country:US
Practice Address - Phone:440-426-2000
Practice Address - Fax:440-693-4168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPEWELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-13
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 320900000X
OH488320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7801301OtherOHIO DODD
OH2686802Medicaid