Healthcare Provider Details

I. General information

NPI: 1326248048
Provider Name (Legal Business Name): HOME BASE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 MOUNTAIN RIDGE RD
BUCKHANNON WV
26201-5117
US

IV. Provider business mailing address

713 BIGLEY AVE
CHARLESTON WV
25302-3356
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-6826
  • Fax: 304-472-8978
Mailing address:
  • Phone: 304-746-2918
  • Fax: 304-472-8978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number135
License Number StateWV

VIII. Authorized Official

Name: MR. DAMON C. CATER
Title or Position: CEO
Credential:
Phone: 304-472-6826