Provider Demographics
NPI:1922124775
Name:JIMMY SIMPSON FOUNDATION, INC.
Entity Type:Organization
Organization Name:JIMMY SIMPSON FOUNDATION, INC.
Other - Org Name:SAFEHAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:SIMPSON
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-375-9520
Mailing Address - Street 1:9558 N HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRING
Mailing Address - State:GA
Mailing Address - Zip Code:30739-2113
Mailing Address - Country:US
Mailing Address - Phone:706-375-9520
Mailing Address - Fax:706-375-9521
Practice Address - Street 1:9558 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:ROCK SPRING
Practice Address - State:GA
Practice Address - Zip Code:30739-2113
Practice Address - Country:US
Practice Address - Phone:706-375-9520
Practice Address - Fax:706-375-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA146001311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility