| Operation Street Harvest, Inc. | |
|
1 W Court Sq Ste 750 Decatur GA 30030-2538 | |
| (678) 978-9391 | |
| Not Available |
| Full Name | Operation Street Harvest, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 1 W Court Sq Ste 750, Decatur, Georgia |
| Authorized Official Name and Position | Tonya Lynn Sumner Brown (CEO/PRESIDENT/CLINICAL SUPERVISOR) |
| Authorized Official Contact | 6789789391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Operation Street Harvest, Inc. 3982 Misty Lk Ellenwood GA 30294-1164 Ph: (678) 978-9391 | Operation Street Harvest, Inc. 1 W Court Sq Ste 750 Decatur GA 30030-2538 Ph: (678) 978-9391 |
| NPI Number | 1376394783 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 04/01/2024 |
| Certification Date | 03/28/2024 |
| Medicare PECOS PAC ID | 8426497652 |
|---|---|
| Medicare Enrollment ID | O20240419002118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376394783 | NPI | - | NPPES |
| Provider Name | Tonya Lynn Sumner Brown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639496169 PECOS PAC ID: 9335588565 Enrollment ID: I20240419002600 |
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