Healthcare Provider Details

I. General information

NPI: 1942165683
Provider Name (Legal Business Name): HOMETOWN CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 N VAN NUYS RD
KINGMAN AZ
86409-2548
US

IV. Provider business mailing address

4295 N VAN NUYS RD
KINGMAN AZ
86409-2548
US

V. Phone/Fax

Practice location:
  • Phone: 928-303-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TREEVA HAUSEN
Title or Position: NURSE PRACTITIONER
Credential: AG-ACNP
Phone: 928-303-3223