Provider Demographics
NPI:1649936931
Name:HOMETOWN PERSONAL CARE SERVICES
Entity type:Organization
Organization Name:HOMETOWN PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUNOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-234-9722
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-0286
Mailing Address - Country:US
Mailing Address - Phone:801-234-9722
Mailing Address - Fax:
Practice Address - Street 1:050 S 1500 W
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642
Practice Address - Country:US
Practice Address - Phone:801-234-9722
Practice Address - Fax:877-586-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4073349Medicaid