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General NPI Number Information
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NPI Number | 1629614714
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Entity Type | Organization
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Legal Business Name | HOME AWAY FROM HOME INC
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Dates
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Enumeration Date | 11/23/2019
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 39042 US HIGHWAY 2
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City | LIBBY
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State | MT
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Zip | 59923-8103
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Country | US
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Telephone | 406-250-3941
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | EUREKA
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State | MT
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Zip | 59917-0535
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Country | US
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Telephone | 406-250-3941
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA A GUCKENBERG
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Credential |
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Telephone | 406-250-3941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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