Provider Demographics
NPI:1821137985
Name:HOME AT LAST, INC.
Entity Type:Organization
Organization Name:HOME AT LAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS
Authorized Official - Phone:407-774-2284
Mailing Address - Street 1:740 FLORIDA CENTRAL PKWY
Mailing Address - Street 2:STE # 1028
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-7651
Mailing Address - Country:US
Mailing Address - Phone:407-774-2284
Mailing Address - Fax:407-774-2285
Practice Address - Street 1:740 FLORIDA CENTRAL PKWY
Practice Address - Street 2:STE # 1028
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-7651
Practice Address - Country:US
Practice Address - Phone:407-774-2284
Practice Address - Fax:407-774-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL676458496Medicaid