Healthcare Provider Details

I. General information

NPI: 1861894198
Provider Name (Legal Business Name): VISION OF HOPE INTERNATIONAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 ARLINGTON AVE SW
ATLANTA GA
30310-3830
US

IV. Provider business mailing address

1074 ARLINGTON AVE SW
ATLANTA GA
30310-3830
US

V. Phone/Fax

Practice location:
  • Phone: 404-272-9214
  • Fax: 404-848-1031
Mailing address:
  • Phone: 404-272-9214
  • Fax: 404-848-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. FABIAN CONAWAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: REVEREND
Phone: 404-272-9214