Provider Demographics
NPI:1568134922
Name:HOME TOWN HEALTHCARE & URGENT CARE
Entity Type:Organization
Organization Name:HOME TOWN HEALTHCARE & URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORLAND-SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:309-258-2804
Mailing Address - Street 1:9377 E 600TH ST
Mailing Address - Street 2:
Mailing Address - City:LYNN CENTER
Mailing Address - State:IL
Mailing Address - Zip Code:61262-9789
Mailing Address - Country:US
Mailing Address - Phone:309-258-2804
Mailing Address - Fax:
Practice Address - Street 1:410 11TH AVE
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:IL
Practice Address - Zip Code:61273-7772
Practice Address - Country:US
Practice Address - Phone:309-258-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty