Provider Demographics
NPI:1235299959
Name:HOMETOWN HOSPICE OF CAMDEN INC
Entity Type:Organization
Organization Name:HOMETOWN HOSPICE OF CAMDEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-246-2727
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:221 CLAIBORNE STREET
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726
Mailing Address - Country:US
Mailing Address - Phone:334-682-4400
Mailing Address - Fax:334-682-9018
Practice Address - Street 1:221 CLAIBORNE STREET
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AL
Practice Address - Zip Code:36726
Practice Address - Country:US
Practice Address - Phone:334-682-4400
Practice Address - Fax:334-682-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11758251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011645Medicare Oscar/Certification