Healthcare Provider Details

I. General information

NPI: 1336510049
Provider Name (Legal Business Name): HOME TOWN HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W MYRTLE ST
INDEPENDENCE KS
67301-3241
US

IV. Provider business mailing address

314 N 7TH ST
FREDONIA KS
66736-1337
US

V. Phone/Fax

Practice location:
  • Phone: 620-332-3215
  • Fax: 620-332-3293
Mailing address:
  • Phone: 620-378-3760
  • Fax: 620-378-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA06300302
License Number StateKS

VIII. Authorized Official

Name: MRS. DEBRA RAE SHINKLE
Title or Position: CHEIF EXECUTIVE OFFICER
Credential: RN
Phone: 620-378-3760