Provider Demographics
NPI:1932521879
Name:HOMETOWN HOME HEALTHCARE
Entity type:Organization
Organization Name:HOMETOWN HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-674-7177
Mailing Address - Street 1:302 E NORTH B ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-1440
Mailing Address - Country:US
Mailing Address - Phone:765-674-7177
Mailing Address - Fax:765-674-7179
Practice Address - Street 1:302 E NORTH B ST
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-1440
Practice Address - Country:US
Practice Address - Phone:765-674-7177
Practice Address - Fax:765-674-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN130133491251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health