Healthcare Provider Details

I. General information

NPI: 1801556287
Provider Name (Legal Business Name): O.N.F.I.Y.A AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 CHIPPING CT
VILLA RICA GA
30180-5839
US

IV. Provider business mailing address

PO BOX 571
VILLA RICA GA
30180-0571
US

V. Phone/Fax

Practice location:
  • Phone: 770-568-8138
  • Fax:
Mailing address:
  • Phone: 770-568-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANEA HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-568-8138