Provider Demographics
NPI:1790869766
Name:HOMEWARD BOUND HOME HEALTH, INC
Entity type:Organization
Organization Name:HOMEWARD BOUND HOME HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-723-6601
Mailing Address - Street 1:130 WEST ELM STREET
Mailing Address - Street 2:P.O. BOX 503
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-0503
Mailing Address - Country:US
Mailing Address - Phone:608-723-6601
Mailing Address - Fax:608-723-6616
Practice Address - Street 1:205 W MAPLE ST STE 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-1642
Practice Address - Country:US
Practice Address - Phone:608-723-6601
Practice Address - Fax:608-723-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI330251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43108500Medicaid
WI=========OtherFEDERAL TAX ID #
WI43108500Medicaid