Provider Demographics
NPI:1073098232
Name:HOMETOWN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-419-1674
Mailing Address - Street 1:292 JERRY LOFTON RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-442-7052
Mailing Address - Fax:
Practice Address - Street 1:5630 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4783
Practice Address - Country:US
Practice Address - Phone:318-704-0025
Practice Address - Fax:318-314-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty