Provider Demographics
NPI:1962589705
Name:HOMEWARD BOUND, INC.
Entity type:Organization
Organization Name:HOMEWARD BOUND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRIEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-525-3186
Mailing Address - Street 1:13895 INDUSTRIAL PARK BLVD
Mailing Address - Street 2:#100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3700
Mailing Address - Country:US
Mailing Address - Phone:763-525-3186
Mailing Address - Fax:763-525-4084
Practice Address - Street 1:7839 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2716
Practice Address - Country:US
Practice Address - Phone:763-566-7860
Practice Address - Fax:763-566-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN802812320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities