Provider Demographics
NPI:1699349480
Name:HOMETOWN HEALTH CENTER PC
Entity type:Organization
Organization Name:HOMETOWN HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:231-652-7810
Mailing Address - Street 1:39011 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3226
Mailing Address - Country:US
Mailing Address - Phone:586-323-8280
Mailing Address - Fax:586-323-8283
Practice Address - Street 1:4388 14 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7838
Practice Address - Country:US
Practice Address - Phone:616-215-5151
Practice Address - Fax:616-215-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy