Provider Demographics
NPI:1417544800
Name:HOME HERITAGE
Entity Type:Organization
Organization Name:HOME HERITAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:OLUSOLA
Authorized Official - Last Name:OKUNNUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-917-1285
Mailing Address - Street 1:76 E WESTFIELD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2237
Mailing Address - Country:US
Mailing Address - Phone:908-917-1285
Mailing Address - Fax:
Practice Address - Street 1:76 E WESTFIELD AVE APT 10
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2237
Practice Address - Country:US
Practice Address - Phone:908-917-1285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities