Provider Demographics
NPI:1649050428
Name:H.O.M.E. HEARTFELT OUTREACH MENTORING ENRICHMENT
Entity type:Organization
Organization Name:H.O.M.E. HEARTFELT OUTREACH MENTORING ENRICHMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-477-4741
Mailing Address - Street 1:139 MORNING GLORY CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-4426
Mailing Address - Country:US
Mailing Address - Phone:336-477-4741
Mailing Address - Fax:
Practice Address - Street 1:139 MORNING GLORY CIR APT 204
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-4426
Practice Address - Country:US
Practice Address - Phone:336-477-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health