Healthcare Provider Details

I. General information

NPI: 1427668268
Provider Name (Legal Business Name): HELPING HANDS OUTREACH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 BROWNING BEND CT
DACULA GA
30019-7770
US

IV. Provider business mailing address

1960 BROWNING BEND CT
DACULA GA
30019-7770
US

V. Phone/Fax

Practice location:
  • Phone: 678-682-1787
  • Fax:
Mailing address:
  • Phone: 678-682-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DAMEKA CHARLES
Title or Position: SECRETARY
Credential:
Phone: 404-451-0342