Healthcare Provider Details

I. General information

NPI: 1669119855
Provider Name (Legal Business Name): HOMETOWN TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

00650 LIETTE LN
SAINT MARYS OH
45885-8503
US

IV. Provider business mailing address

00650 LIETTE LN
SAINT MARYS OH
45885-8503
US

V. Phone/Fax

Practice location:
  • Phone: 419-962-9405
  • Fax:
Mailing address:
  • Phone: 419-962-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE RENEE MILLER
Title or Position: CO-OWNER
Credential: OWNER
Phone: 419-962-9405