Provider Demographics
NPI:1326473497
Name:HOMETOWN FAMILY HEALTH
Entity Type:Organization
Organization Name:HOMETOWN FAMILY HEALTH
Other - Org Name:HOMETOWN FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-249-8528
Mailing Address - Street 1:103 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3703
Mailing Address - Country:US
Mailing Address - Phone:360-249-8528
Mailing Address - Fax:888-990-3893
Practice Address - Street 1:103 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3703
Practice Address - Country:US
Practice Address - Phone:360-249-8528
Practice Address - Fax:888-990-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty