Healthcare Provider Details

I. General information

NPI: 1770099848
Provider Name (Legal Business Name): HI-HOPE SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 HI HOPE RD
LAWRENCEVILLE GA
30043-4543
US

IV. Provider business mailing address

882 HI HOPE RD
LAWRENCEVILLE GA
30043-4543
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-8694
  • Fax:
Mailing address:
  • Phone: 770-963-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: ROY CURTIS HARRISON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 770-963-8694