Provider Demographics
NPI:1083064695
Name:HOME BASE INC.
Entity Type:Organization
Organization Name:HOME BASE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:CASE
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER, CEO
Authorized Official - Phone:304-746-2918
Mailing Address - Street 1:PO BOX 20033
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25362-1033
Mailing Address - Country:US
Mailing Address - Phone:304-746-2918
Mailing Address - Fax:304-746-2919
Practice Address - Street 1:713 BIGLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3356
Practice Address - Country:US
Practice Address - Phone:304-746-2918
Practice Address - Fax:304-746-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV440101YA0400X, 101YM0800X, 101YP2500X, 103T00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV440OtherWEST VIRGINIA BEHAVIORAL HEALTHCARE LICENSE
WV9435000000Medicaid
WV9435000001Medicaid