Healthcare Provider Details

I. General information

NPI: 1447181045
Provider Name (Legal Business Name): SISTER CODE HAVEN INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON ST UNIT 122
FAIRBURN GA
30213-3601
US

IV. Provider business mailing address

75 WASHINGTON ST UNIT 122
FAIRBURN GA
30213-3601
US

V. Phone/Fax

Practice location:
  • Phone: 281-901-4717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: CHRISTEN LYNNETTE GREEN
Title or Position: OWNER
Credential:
Phone: 470-629-2868