Provider Demographics
NPI:1295136489
Name:HOME OF POSSIBILITIES
Entity type:Organization
Organization Name:HOME OF POSSIBILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENIEMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-540-9011
Mailing Address - Street 1:8224 BRIGGS GULLY ST
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89085-4431
Mailing Address - Country:US
Mailing Address - Phone:702-575-7140
Mailing Address - Fax:
Practice Address - Street 1:8224 BRIGGS GULLY ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89085-4431
Practice Address - Country:US
Practice Address - Phone:702-575-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20091454427251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid