Provider Demographics
NPI:1629614714
Name:HOME AWAY FROM HOME INC
Entity Type:Organization
Organization Name:HOME AWAY FROM HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUCKENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-250-3941
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-0535
Mailing Address - Country:US
Mailing Address - Phone:406-250-3941
Mailing Address - Fax:
Practice Address - Street 1:39042 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-8103
Practice Address - Country:US
Practice Address - Phone:406-250-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility