1467645044 NPI number — HARVESTLODGE HOMES AND SERVICES FOR CHILDREN AND FAMILIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467645044 NPI number — HARVESTLODGE HOMES AND SERVICES FOR CHILDREN AND FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVESTLODGE HOMES AND SERVICES FOR CHILDREN AND FAMILIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467645044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3467 HUNTERS HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHONIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30038-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-981-2903
Provider Business Mailing Address Fax Number:
770-808-6648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4187 CONNOR DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENWOOD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-981-2903
Provider Business Practice Location Address Fax Number:
770-808-6648
Provider Enumeration Date:
08/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPARKS
Authorized Official First Name:
DANNETTA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO/DIRECTOR
Authorized Official Telephone Number:
770-981-2903

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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