Provider Demographics
NPI:1376934133
Name:THE HOME PLACE, LLC
Entity Type:Organization
Organization Name:THE HOME PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHERANN
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-880-0044
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-0763
Mailing Address - Country:US
Mailing Address - Phone:406-880-0044
Mailing Address - Fax:
Practice Address - Street 1:401 SEELEY LN
Practice Address - Street 2:
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868-8702
Practice Address - Country:US
Practice Address - Phone:406-880-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home