Provider Demographics
| NPI: | 1891820668 |
|---|---|
| Name: | HOPEBRIDGE, LLC |
| Entity type: | Organization |
| Organization Name: | HOPEBRIDGE, LLC |
| Other - Org Name: | <UNAVAIL> |
| 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 |
| Mailing Address - Street 2: | SUITE 3070 |
| 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: | 317-763-2099 |
| Practice Address - Street 1: | 1558 E BOULEVARD STE A |
| Practice Address - Street 2: | |
| Practice Address - City: | KOKOMO |
| Practice Address - State: | IN |
| Practice Address - Zip Code: | 46902-2479 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 765-252-0530 |
| Practice Address - Fax: | 317-520-8200 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-02-22 |
| Last Update Date: | 2025-03-24 |
| 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 | 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 | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 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 |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IN | 000000975491 | Other | ANTHEM |
| IN | 200533240 A, C-I | Medicaid | |
| OK | 201036870C | Medicaid | |
| OK | 201036870A | Medicaid | |
| IN | 300007293 | Medicaid | |
| IN | 300007369 | Medicaid | |
| IN | 3000013388 | Medicaid | |
| IN | 200925340A-I | Medicaid | |
| IN | 300006160 | Medicaid | |
| IN | 300007629 | Medicaid | |
| IN | 300007160 | Medicaid | |
| IN | 300007183 | Medicaid | |
| KY | 7100493250 | Medicaid |
