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General NPI Number Information
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NPI Number | 1073544698
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Entity Type | Organization
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Legal Business Name | HOMETOWN HOMECARE LLC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 350 MAGNOLIA AVE SW 300
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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Country | US
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Telephone | 863-401-3550
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Fax | 863-401-8199
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Provider Business Mailing Address
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Address Line | 250 MAGNOLIA AVE SW STE 300
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City | WINTER HAVEN
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State | FL
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Zip | 33880-2901
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Country | US
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Telephone | 863-401-3550
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Fax | 863-401-8199
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Authorized Official
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Title or Position | OWNER CEO
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Name | DAVID O SULLIVAN
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Credential |
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Telephone | 863-401-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299991974
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License Number State |
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