Provider Demographics
NPI:1245522655
Name:HOMETOWN HEALTHCARE OF DESOTO LLC
Entity type:Organization
Organization Name:HOMETOWN HEALTHCARE OF DESOTO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:AMES-POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:636-337-5522
Mailing Address - Street 1:106 EASTON ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-1706
Mailing Address - Country:US
Mailing Address - Phone:636-337-5522
Mailing Address - Fax:636-337-5525
Practice Address - Street 1:106 EASTON ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1706
Practice Address - Country:US
Practice Address - Phone:636-337-5522
Practice Address - Fax:636-337-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty