Provider Demographics
NPI:1427013531
Name:THE HOMEPLACE SHELTER INC.
Entity Type:Organization
Organization Name:THE HOMEPLACE SHELTER INC.
Other - Org Name:MILDRED'S HOMEPLACE LLL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-228-1985
Mailing Address - Street 1:612 E CLAY ST
Mailing Address - Street 2:357 A&B SHORELINE DRIVE
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4608
Mailing Address - Country:US
Mailing Address - Phone:229-551-0695
Mailing Address - Fax:229-551-0694
Practice Address - Street 1:612 E CLAY ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4608
Practice Address - Country:US
Practice Address - Phone:229-551-0695
Practice Address - Fax:229-551-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1998-A101YA0400X
GA251B00000X, 251K00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable