Provider Demographics
NPI:1649764762
Name:TONYA CLARK FREEMAN
Entity Type:Organization
Organization Name:TONYA CLARK FREEMAN
Other - Org Name:THE HOME PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-356-9954
Mailing Address - Street 1:404 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-8879
Mailing Address - Country:US
Mailing Address - Phone:252-642-4666
Mailing Address - Fax:252-356-9954
Practice Address - Street 1:404 W RIVER ST
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924-8879
Practice Address - Country:US
Practice Address - Phone:252-642-4666
Practice Address - Fax:252-356-9954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TONYA CLARK FREEMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH008043311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home