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General NPI Number Information
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NPI Number | 1215850961
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN PERSONAL CARE LLC
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 650 MAIN ST
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City | WARRENTON
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State | GA
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Zip | 30828-8308
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Country | US
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Telephone | 706-465-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 REYNOLDS CIR
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City | GROVETOWN
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State | GA
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Zip | 30813-1257
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Country | US
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Telephone | 706-830-4945
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRANDON BERNARD HEATH
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Credential | HEATH
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Telephone | 706-830-4945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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