Provider Demographics
NPI:1881771509
Name:HOMETOWN HOMECARE LLC
Entity type:Organization
Organization Name:HOMETOWN HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:FRENCH
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:229-551-0089
Mailing Address - Street 1:PO BOX 6222
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31758-6222
Mailing Address - Country:US
Mailing Address - Phone:229-551-0089
Mailing Address - Fax:
Practice Address - Street 1:508 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6646
Practice Address - Country:US
Practice Address - Phone:229-551-0089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA301621200332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000919388AMedicaid
GA000919388AMedicaid