Provider Demographics
NPI: | 1326537994 |
---|---|
Name: | HOPEBRIDGE, LLC |
Entity type: | Organization |
Organization Name: | HOPEBRIDGE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | INSURANCE & CREDENTIALING MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANGIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GRAFF |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 317-376-8336 |
Mailing Address - Street 1: | 3500 DEPAUW BLVD STE 3070 |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46268-6135 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 855-324-0885 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 490 WHITE POND DR |
Practice Address - Street 2: | |
Practice Address - City: | AKRON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44320-1122 |
Practice Address - Country: | US |
Practice Address - Phone: | 855-324-0885 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HOPEBRIDGE, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-05-09 |
Last Update Date: | 2021-06-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |