Provider Demographics
NPI:1205925393
Name:YOUR H.O.M.E., INC
Entity type:Organization
Organization Name:YOUR H.O.M.E., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAKELA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:828-652-2504
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-0069
Mailing Address - Country:US
Mailing Address - Phone:828-652-2504
Mailing Address - Fax:828-659-2518
Practice Address - Street 1:120 FLEMING AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-0069
Practice Address - Country:US
Practice Address - Phone:828-652-2504
Practice Address - Fax:828-659-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL059027310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805078Medicaid