Provider Demographics
NPI:1417395815
Name:HOMETOWN CARE LLC
Entity Type:Organization
Organization Name:HOMETOWN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-639-9440
Mailing Address - Street 1:1871 US HIGHWAY 41A S
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:KY
Mailing Address - Zip Code:42409-9448
Mailing Address - Country:US
Mailing Address - Phone:270-639-9440
Mailing Address - Fax:270-664-2698
Practice Address - Street 1:1871 US HIGHWAY 41A S
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:KY
Practice Address - Zip Code:42409-9448
Practice Address - Country:US
Practice Address - Phone:270-639-9440
Practice Address - Fax:270-664-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty