Provider Demographics
NPI:1114063070
Name:HOPE HAVEN OF NORTHEAST GEORGIA, INC.
Entity Type:Organization
Organization Name:HOPE HAVEN OF NORTHEAST GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-548-4361
Mailing Address - Street 1:795 NEWTON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1303
Mailing Address - Country:US
Mailing Address - Phone:706-548-4361
Mailing Address - Fax:706-548-9602
Practice Address - Street 1:795 NEWTON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1303
Practice Address - Country:US
Practice Address - Phone:706-548-4361
Practice Address - Fax:706-548-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00658754CMedicaid