Provider Demographics
NPI:1326046566
Name:HOMETOWN HOSPICE, LLC
Entity Type:Organization
Organization Name:HOMETOWN HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-681-4440
Mailing Address - Street 1:2307 S YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-8876
Mailing Address - Country:US
Mailing Address - Phone:918-681-4440
Mailing Address - Fax:918-681-4428
Practice Address - Street 1:2307 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-8876
Practice Address - Country:US
Practice Address - Phone:918-681-4440
Practice Address - Fax:918-681-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4059251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371546Medicare ID - Type UnspecifiedMEDICARE PROVIDER #