Healthcare Provider Details

I. General information

NPI: 1811032303
Provider Name (Legal Business Name): HOPE HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 MILLEDGEVILLE RD
AUGUSTA GA
30904-0407
US

IV. Provider business mailing address

PO BOX 3597
AUGUSTA GA
30914-3597
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-9879
  • Fax: 706-737-9830
Mailing address:
  • Phone: 706-737-9879
  • Fax: 706-737-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number121-524-D
License Number StateGA

VIII. Authorized Official

Name: DR. GERALD O CARRIER
Title or Position: EXECUTIVE DIRECTOR
Credential: PH. D.
Phone: 706-737-9879