Provider Demographics
NPI:1598069957
Name:HOMEBOUND PRIMARY CARE LLC
Entity Type:Organization
Organization Name:HOMEBOUND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN, MSN, ANP-BC
Authorized Official - Phone:855-550-5605
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-0208
Mailing Address - Country:US
Mailing Address - Phone:855-550-5605
Mailing Address - Fax:
Practice Address - Street 1:18211 GIFFORD RD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:OH
Practice Address - Zip Code:44090-8910
Practice Address - Country:US
Practice Address - Phone:855-550-5605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10202363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1063665024OtherEMPLOYEE NPI
OH3130865Medicaid