Healthcare Provider Details

I. General information

NPI: 1396105599
Provider Name (Legal Business Name): HOPE YOUTH AND FAMILY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 BASTILLE WAY SUITE A
FAYETTEVILLE GA
30214-7652
US

IV. Provider business mailing address

170 BASTILLE WAY SUITE A
FAYETTEVILLE GA
30214-7652
US

V. Phone/Fax

Practice location:
  • Phone: 404-509-9508
  • Fax:
Mailing address:
  • Phone: 404-509-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DEMETRIUS D ROMAN
Title or Position: EXECUTIVE DIRECTOR/ OWNER
Credential: D.O.
Phone: 404-509-9508