Provider Demographics
NPI:1366165789
Name:OLD HOME PLACE INC
Entity type:Organization
Organization Name:OLD HOME PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUSTON
Authorized Official - Middle Name:LABRANTE
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-454-1507
Mailing Address - Street 1:406 OGLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826
Mailing Address - Country:US
Mailing Address - Phone:443-454-1507
Mailing Address - Fax:443-859-8953
Practice Address - Street 1:406 OGLE AVENUE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826
Practice Address - Country:US
Practice Address - Phone:443-454-1507
Practice Address - Fax:443-859-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home