Provider Demographics
NPI:1225149586
Name:HOME TOWN HEALTH CARE, LLC
Entity Type:Organization
Organization Name:HOME TOWN HEALTH CARE, LLC
Other - Org Name:HOME TOWN HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SHINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-378-3760
Mailing Address - Street 1:314 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1337
Mailing Address - Country:US
Mailing Address - Phone:620-378-3760
Mailing Address - Fax:620-378-3765
Practice Address - Street 1:314 N 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1337
Practice Address - Country:US
Practice Address - Phone:620-378-3760
Practice Address - Fax:620-378-3765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA103006H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00425730BMedicaid
KS200425730AMedicaid
KS0000118441OtherBCBSKS
KS200425730AMedicaid