Healthcare Provider Details

I. General information

NPI: 1093645483
Provider Name (Legal Business Name): YOUR HOME AWAY FROM HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CORWIN CIR
HAMPTON VA
23666-1400
US

IV. Provider business mailing address

21 CORWIN CIR
HAMPTON VA
23666-1400
US

V. Phone/Fax

Practice location:
  • Phone: 347-462-5005
  • Fax:
Mailing address:
  • Phone: 347-462-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MEL CHRISTIEN DAVIS
Title or Position: CEO
Credential:
Phone: 347-462-5005