Provider Demographics
NPI:1831302520
Name:HOMETOWN HOSPICE INC
Entity Type:Organization
Organization Name:HOMETOWN HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARVLE
Authorized Official - Last Name:KINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-626-7277
Mailing Address - Street 1:8366 HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9395
Mailing Address - Country:US
Mailing Address - Phone:601-626-7277
Mailing Address - Fax:601-626-8988
Practice Address - Street 1:8366 HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39325-9395
Practice Address - Country:US
Practice Address - Phone:601-626-7277
Practice Address - Fax:601-626-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS046251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0770285Medicaid
MS000070039OtherBC BS
MS0770285Medicaid