Provider Demographics
NPI:1265486658
Name:HOMETOWN HEALTHCARE INC.
Entity Type:Organization
Organization Name:HOMETOWN HEALTHCARE INC.
Other - Org Name:HOMETOWN HEALTHCARE AND MEDICAL EQUIPMEMNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-456-4630
Mailing Address - Street 1:107 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2225
Mailing Address - Country:US
Mailing Address - Phone:662-456-4630
Mailing Address - Fax:662-456-2262
Practice Address - Street 1:107 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2225
Practice Address - Country:US
Practice Address - Phone:662-456-4630
Practice Address - Fax:662-456-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06827/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08056844Medicaid
MS08056844Medicaid