Provider Demographics
NPI:1497067417
Name:HOMETOWN CARE
Entity Type:Organization
Organization Name:HOMETOWN CARE
Other - Org Name:HOMETOWN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-823-0223
Mailing Address - Street 1:606 CRIM AVE
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-9424
Mailing Address - Country:US
Mailing Address - Phone:304-823-0223
Mailing Address - Fax:304-823-0224
Practice Address - Street 1:66 S. CRIM AVE
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9424
Practice Address - Country:US
Practice Address - Phone:304-823-0223
Practice Address - Fax:304-823-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22368317171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1497067417Medicaid