MEDICARE: HOMETOWN MEDICAL & REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SR GHC 102 062635	OTHER	CA	SELLERS PERMIT

General Provider Information

NPI Number	:	1043428022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN MEDICAL & REHAB

Provider Business Mailing Address
First Line	:	740 FRONT ST STE 170
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4536
Country	:	US
Telephone Number	:	831-423-6909
Fax Number	:	831-423-6900

Provider Business Practice Location Address
First Line	:	740 FRONT ST STE 170
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4536
Country	:	US
Telephone Number	:	831-423-6909
Fax Number	:	831-423-6900

Authorized Official
Title or Position	:	OWNER
Name	:	DOROTHY AGUILAR
Credential	:
Telephone Number	:	831-423-6909

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	05/11/2011

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Directions to “HOMETOWN MEDICAL & REHAB ” Practice Location

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