Provider Demographics
NPI:1285006627
Name:HOMESPACE CORP.
Entity Type:Organization
Organization Name:HOMESPACE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:716-881-4600
Mailing Address - Street 1:1030 ELLICOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2127
Mailing Address - Country:US
Mailing Address - Phone:716-881-4600
Mailing Address - Fax:716-881-4604
Practice Address - Street 1:1030 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2127
Practice Address - Country:US
Practice Address - Phone:716-881-4600
Practice Address - Fax:716-881-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service