Provider Demographics
NPI:1558078238
Name:HOMETOWN PERSONAL CARE, LLC
Entity Type:Organization
Organization Name:HOMETOWN PERSONAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-508-2385
Mailing Address - Street 1:157 INMAN CT # B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-9628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 INMAN CT # B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-9628
Practice Address - Country:US
Practice Address - Phone:812-508-2385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care