Healthcare Provider Details

I. General information

NPI: 1518478957
Provider Name (Legal Business Name): HOME AWAY FROM HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 MEADOWBROOK LANE W.
WILSON NC
27893
US

IV. Provider business mailing address

1723 MEADOWBROOK LANE W.
WILSON NC
27803
US

V. Phone/Fax

Practice location:
  • Phone: 252-296-9459
  • Fax:
Mailing address:
  • Phone: 252-296-9459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN PAULETTE SPEIGHT
Title or Position: PRESIDENT
Credential:
Phone: 919-539-5714