Organization
HOME BASE INC MDGRP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAMON C. CATER (CEO)
(304) 472-8707
Entity
Organization
Contact information
Practice address
5 1/2 W MAIN ST, BUCKHANNON, WV 26201-2235
(304) 472-8707
(304) 472-8978
Mailing address
PO BOX 2024, BUCKHANNON, WV 26201-7024
(304) 472-8707
(304) 472-8978
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
135
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810007185
—
WV
Enumeration date
04/24/2008
Last updated
04/24/2008
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