Provider Demographics
NPI:1023840519
Name:HOME AWAY FROM HOME CHILD SERVICES
Entity type:Organization
Organization Name:HOME AWAY FROM HOME CHILD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-325-6171
Mailing Address - Street 1:201 WINBORNE LN
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1562
Mailing Address - Country:US
Mailing Address - Phone:252-325-6171
Mailing Address - Fax:
Practice Address - Street 1:201 WINBORNE LN
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1562
Practice Address - Country:US
Practice Address - Phone:252-325-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health