Provider Demographics
NPI:1700567740
Name:HOMEFRONT HOME CARE LLC
Entity Type:Organization
Organization Name:HOMEFRONT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BOTTERON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:317-801-0390
Mailing Address - Street 1:9025 COLDWATER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2074
Mailing Address - Country:US
Mailing Address - Phone:260-704-3922
Mailing Address - Fax:
Practice Address - Street 1:9025 COLDWATER RD STE 300
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2074
Practice Address - Country:US
Practice Address - Phone:260-704-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care