Provider Demographics
NPI:1598750036
Name:HOMETOWN CARE CENTER LLC
Entity Type:Organization
Organization Name:HOMETOWN CARE CENTER LLC
Other - Org Name:HOMETOWN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LIC. NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:254-853-2631
Mailing Address - Street 1:220 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:TX
Mailing Address - Zip Code:76557-3848
Mailing Address - Country:US
Mailing Address - Phone:254-853-2631
Mailing Address - Fax:254-853-9328
Practice Address - Street 1:220 8TH ST
Practice Address - Street 2:
Practice Address - City:MOODY
Practice Address - State:TX
Practice Address - Zip Code:76557-3848
Practice Address - Country:US
Practice Address - Phone:254-853-2631
Practice Address - Fax:254-853-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110238313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility