The Homeplace Shelter Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

136-01-096-1 Issued in GA

Legal business name

THE HOMEPLACE SHELTER INC.

Doing business as

Mildred's HomePlace III

Practice address

612 E Clay St
Thomasville, GA 31792-4608

Phone

(229) 551-0695

Fax

(229) 551-0694

NPI assigned

Aug 26, 2009

Organization subpart

Yes

Parent organization

THE HOMEPLACE SHELTER INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Nancy Lee Mitchell

Title

Administrator

Phone

(229) 228-1985

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Mildred's HomePlace III Doing business as

Tax ID family

Mildred's Homeplace III3 organizations share this tax ID, including this one

Part of

Mildred's Homeplace III

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Mildred's Homeplace III

  dba The HomePlace Shelter Inc.

  • Community Based Hospice Care Agency
  • Thomasville, GA
  • NPI 1073847703
  NPD tax ID
• The Homeplace Shelter Inc.

  dba mildred's homeplace lll

  • Case Management Agency
  • Thomasville, GA
  • NPI 1427013531
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• The Homeplace Shelter Inc.

  dba mildred's homeplace lll

  • Case Management Agency
  • Thomasville, GA
  • NPI 1427013531
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251244800000",
    "number": "1346473246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 E CLAY ST",
            "address_2": "610 EAST CLAY STREET",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924608",
            "telephone_number": "229-551-0695",
            "fax_number": "229-551-0694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 E CLAY ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924608",
            "telephone_number": "229-551-0695",
            "fax_number": "229-551-0694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HOMEPLACE SHELTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE HOMEPLACE SHELTER INC.",
        "enumeration_date": "2009-08-26",
        "last_updated": "2009-08-26",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "229-228-1985",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "GA",
            "license": "136-01-096-1",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "136-01-096-1",
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "GA",
            "license": "136-01-096-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CARE HOME",
            "identifier": "136-01-096-1",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mildred's HomePlace III",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.