Provider Demographics
NPI:1407220395
Name:HOMETOWN CARE PROVIDERS
Entity Type:Organization
Organization Name:HOMETOWN CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-430-6175
Mailing Address - Street 1:175 80TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLARA CITY
Mailing Address - State:MN
Mailing Address - Zip Code:56222-1221
Mailing Address - Country:US
Mailing Address - Phone:320-564-3308
Mailing Address - Fax:
Practice Address - Street 1:175 80TH AVE NE
Practice Address - Street 2:
Practice Address - City:CLARA CITY
Practice Address - State:MN
Practice Address - Zip Code:56222-1221
Practice Address - Country:US
Practice Address - Phone:320-564-3308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility