Provider Demographics
NPI:1275027294
Name:THE HOME PLACE
Entity Type:Organization
Organization Name:THE HOME PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-356-9954
Mailing Address - Street 1:404 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-8879
Mailing Address - Country:US
Mailing Address - Phone:252-356-9954
Mailing Address - Fax:
Practice Address - Street 1:404 W RIVER ST
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924-8879
Practice Address - Country:US
Practice Address - Phone:252-356-9954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL008043311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFCL008043OtherDHHS FAMILY CARE HOME LICENSE