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General NPI Number Information
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NPI Number | 1326248048
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Entity Type | Organization
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Legal Business Name | HOME BASE INC.
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 1362 MOUNTAIN RIDGE RD
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City | BUCKHANNON
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State | WV
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Zip | 26201-5117
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Country | US
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Telephone | 304-473-6826
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Fax | 304-472-8978
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Provider Business Mailing Address
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Address Line | 713 BIGLEY AVE
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City | CHARLESTON
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State | WV
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Zip | 25302-3356
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Country | US
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Telephone | 304-746-2918
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Fax | 304-472-8978
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Authorized Official
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Title or Position | CEO
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Name | MR. DAMON C. CATER
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Credential |
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Telephone | 304-472-6826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 135
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License Number State | WV
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