Provider Demographics
NPI:1730545112
Name:HOME OF POSSIBILITIES
Entity type:Organization
Organization Name:HOME OF POSSIBILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:RON
Authorized Official - Last Name:BIENIEMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-549-7044
Mailing Address - Street 1:400 S 4TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6207
Mailing Address - Country:US
Mailing Address - Phone:702-793-4233
Mailing Address - Fax:
Practice Address - Street 1:400 S 4TH ST STE 500
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6207
Practice Address - Country:US
Practice Address - Phone:702-793-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538499876Medicaid