Provider Demographics
NPI:1043425416
Name:HAVEN HEART'S COMMUNITY DEVELOPMENT CENTER, INC.
Entity Type:Organization
Organization Name:HAVEN HEART'S COMMUNITY DEVELOPMENT CENTER, INC.
Other - Org Name:AUGUSTA COMMUNITY RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-485-2202
Mailing Address - Street 1:5604 WENDY BAGWELL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HIRIAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7814
Mailing Address - Country:US
Mailing Address - Phone:770-485-2202
Mailing Address - Fax:770-575-0456
Practice Address - Street 1:5604 WENDY BAGWELL PARKWAY
Practice Address - Street 2:SUITE 211
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7814
Practice Address - Country:US
Practice Address - Phone:770-485-2202
Practice Address - Fax:770-575-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA040676383AMedicaid