Provider Demographics
NPI:1467645044
Name:HARVESTLODGE HOMES AND SERVICES FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:HARVESTLODGE HOMES AND SERVICES FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNETTA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-981-2903
Mailing Address - Street 1:3467 HUNTERS HILL DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1614
Mailing Address - Country:US
Mailing Address - Phone:770-981-2903
Mailing Address - Fax:770-808-6648
Practice Address - Street 1:4187 CONNOR DR.
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294
Practice Address - Country:US
Practice Address - Phone:770-981-2903
Practice Address - Fax:770-808-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health