Healthcare Provider Details

I. General information

NPI: 1992879969
Provider Name (Legal Business Name): HAVEN OF HOPE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 GIBBS RD S
GROVETOWN GA
30813-3165
US

IV. Provider business mailing address

652 GIBBS RD S
GROVETOWN GA
30813-3165
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-4378
  • Fax:
Mailing address:
  • Phone: 706-860-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREA B GRIER
Title or Position: PRESIDENT
Credential:
Phone: 706-860-4378