=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619407822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HOPE ASSISTANT LIVING OF GEORGIA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3985 FLAT SHOALS RD
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-692-4240
-----------------------------------------------------
Fax | 770-692-4245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3985 FLAT SHOALS RD
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-1588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-692-4240
-----------------------------------------------------
Fax | 770-692-4245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE ADMINISTRATIVE ASSISTANT
-----------------------------------------------------
Name | ANNA COTTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-692-3875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311Z00000X
-----------------------------------------------------
Taxonomy Name | Custodial Care Facility
-----------------------------------------------------
License Number | 060-02-047-1
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------