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General NPI Number Information
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NPI Number | 1215076740
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Entity Type | Organization
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Legal Business Name | HOMEPLACE SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 S 4TH ST SUITE #2
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City | DANVILLE
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State | KY
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Zip | 40422-1827
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Country | US
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Telephone | 859-936-2010
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Fax | 859-936-2099
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Provider Business Mailing Address
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Address Line | 215 S 4TH ST SUITE #2
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City | DANVILLE
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State | KY
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Zip | 40422-1827
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Country | US
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Telephone | 859-936-2010
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Fax | 859-936-2099
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Authorized Official
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Title or Position | PROGRAM SUPERVISOR
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Name | AMBER ESTES
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Credential | LPN
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Telephone | 859-936-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 33001249
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License Number State | KY
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