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NPI Code Detail

MEDICARE: HOME BASE INC.

MEDICARE: HOME BASE INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency135WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871980557
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOME BASE INC.
Provider Business Mailing Address
First Line : 713 BIGLEY AVE.
Second Line :
City : CHARLESTON
State : WV
Zip : 25302
Country : US
Telephone Number : 304-746-2918
Fax Number : 304-746-2919
Provider Business Practice Location Address
First Line : 713 BIGLEY AVE
Second Line :
City : CHARLESTON
State : WV
Zip : 25302-3356
Country : US
Telephone Number : 304-746-2918
Fax Number : 304-746-2919
Authorized Official
Title or Position : CEO
Name : DAMON C CATER
Credential :
Telephone Number : 304-678-4159
Provider Enumeration Date : 04/21/2015
Last Update Date : 04/21/2015

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Directions to “HOME BASE INC. ” Practice Location

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