Provider Demographics
NPI:1861496531
Name:HOWARD COUNTY HOME HEALTH AND HOSPICE
Entity Type:Organization
Organization Name:HOWARD COUNTY HOME HEALTH AND HOSPICE
Other - Org Name:HOMETOWN HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIEHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN CHCE
Authorized Official - Phone:660-248-2100
Mailing Address - Street 1:101 FURR STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1069
Mailing Address - Country:US
Mailing Address - Phone:660-248-2100
Mailing Address - Fax:660-248-3347
Practice Address - Street 1:101 FURR STREET
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1069
Practice Address - Country:US
Practice Address - Phone:660-248-2100
Practice Address - Fax:660-248-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106-22251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580562908Medicaid
MO32123OtherBLUE CROSS
MO39282OtherHEALTHCARE USA
MO580562908Medicaid
MO=========HOSOtherMERCY
MO=========OtherMOST PRIVATE INSURANCES
MO=========OtherMOST PRIVATE INSURANCES