Provider Demographics
NPI:1184347049
Name:PHOENIX HAVEN AFRICA INC.
Entity type:Organization
Organization Name:PHOENIX HAVEN AFRICA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TATO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYFLORSEE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR, MPA
Authorized Official - Phone:404-437-9073
Mailing Address - Street 1:3808 PROSPECT POINT DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-0350
Mailing Address - Country:US
Mailing Address - Phone:470-872-7208
Mailing Address - Fax:
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5727
Practice Address - Country:US
Practice Address - Phone:470-593-8438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174200000XOther Service ProvidersMealsGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No332U00000XSuppliersHome Delivered Meals
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty