=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043248651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAKER'S HOME INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 BRACEY ST
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23851-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-516-6100
-----------------------------------------------------
Fax | 757-569-0052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 HARBOR COVE DR
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77381-3339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-647-8897
-----------------------------------------------------
Fax | 281-362-9049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CLARENCE R BAKER SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-647-8897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 508-02-029
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------