Healthcare Provider Details

I. General information

NPI: 1417359308
Provider Name (Legal Business Name): HOPE HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 HIGHLAND AVE
AUGUSTA GA
30904-5638
US

IV. Provider business mailing address

PO BOX 3597
AUGUSTA GA
30914-3597
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-9879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN SALTZMAN
Title or Position: CEO
Credential:
Phone: 706-737-9879