Provider Demographics
NPI:1639435795
Name:HOMETOWN MEDICAL REHAB
Entity Type:Organization
Organization Name:HOMETOWN MEDICAL REHAB
Other - Org Name:HOMETOWN MEDICAL REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-435-1587
Mailing Address - Street 1:671 CHEMEKETA DR
Mailing Address - Street 2:A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3039
Mailing Address - Country:US
Mailing Address - Phone:831-435-1587
Mailing Address - Fax:877-421-2401
Practice Address - Street 1:671 CHEMEKETA DR
Practice Address - Street 2:A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3039
Practice Address - Country:US
Practice Address - Phone:831-435-1587
Practice Address - Fax:877-421-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102208089332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies