Provider Demographics
NPI:1922631779
Name:HOMEGROWN COMMUNICATION-SLP, LLC
Entity Type:Organization
Organization Name:HOMEGROWN COMMUNICATION-SLP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:352-871-6882
Mailing Address - Street 1:5163 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3145
Mailing Address - Country:US
Mailing Address - Phone:352-871-6882
Mailing Address - Fax:904-212-0363
Practice Address - Street 1:5163 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3145
Practice Address - Country:US
Practice Address - Phone:352-871-6882
Practice Address - Fax:904-212-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty