Healthcare Provider Details

I. General information

NPI: 1609422237
Provider Name (Legal Business Name): PLACE OF HOPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 JONESBORO RD
LAKE CITY GA
30260-3504
US

IV. Provider business mailing address

5405 JONESBORO RD
LAKE CITY GA
30260-3504
US

V. Phone/Fax

Practice location:
  • Phone: 404-259-0780
  • Fax: 404-608-9719
Mailing address:
  • Phone: 404-259-0780
  • Fax: 404-608-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTIANA ODUGUNWA
Title or Position: CEO
Credential:
Phone: 404-259-0780