Provider Demographics
NPI:1669122966
Name:HOME TOWN HEALTH CARE, LLC
Entity type:Organization
Organization Name:HOME TOWN HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-378-3760
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:LYNDON
Mailing Address - State:KS
Mailing Address - Zip Code:66451-0481
Mailing Address - Country:US
Mailing Address - Phone:785-310-0001
Mailing Address - Fax:785-828-3318
Practice Address - Street 1:715 WASHINGTON ST STE B
Practice Address - Street 2:
Practice Address - City:LYNDON
Practice Address - State:KS
Practice Address - Zip Code:66451-9870
Practice Address - Country:US
Practice Address - Phone:785-310-0001
Practice Address - Fax:785-828-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA0560123OtherKDHE
KS30003880380007Medicaid