MEDICARE: HEAVEN SENT SECOND CHANCE TRANSITIONAL SAFEHOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043169642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVEN SENT SECOND CHANCE TRANSITIONAL SAFEHOUSE

Provider Business Mailing Address
First Line	:	1445 WOODMONT LN NW STE 744
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	844-467-9943
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 WILLIAMS BLF
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-6162
Country	:	US
Telephone Number	:	844-467-9943
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAURICE SHAHID
Credential	:
Telephone Number	:	844-467-9943

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “HEAVEN SENT SECOND CHANCE TRANSITIONAL SAFEHOUSE ” Practice Location

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