Provider Demographics
NPI:1659049351
Name:MYHOME ,LLC
Entity Type:Organization
Organization Name:MYHOME ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MR
Authorized Official - Prefix:
Authorized Official - First Name:DAGET
Authorized Official - Middle Name:AYANA
Authorized Official - Last Name:TEGEGNE
Authorized Official - Suffix:
Authorized Official - Credentials:TECHNOLOGIST
Authorized Official - Phone:704-963-5277
Mailing Address - Street 1:6418 REDDMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-4541
Mailing Address - Country:US
Mailing Address - Phone:980-209-0704
Mailing Address - Fax:
Practice Address - Street 1:6418 REDDMAN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-4541
Practice Address - Country:US
Practice Address - Phone:980-209-0704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness