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General NPI Number Information
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NPI Number | 1225149586
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Entity Type | Organization
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Legal Business Name | HOME TOWN HEALTH CARE, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 314 N 7TH ST
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City | FREDONIA
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State | KS
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Zip | 66736-1337
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Country | US
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Telephone | 620-378-3760
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Fax | 620-378-3765
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Provider Business Mailing Address
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Address Line | 314 N 7TH ST
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City | FREDONIA
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State | KS
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Zip | 66736-1337
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Country | US
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Telephone | 620-378-3760
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Fax | 620-378-3765
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Authorized Official
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Title or Position | RN ADMINISTRATOR
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Name | MRS. DEBRA RAE SHINKLE
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Credential | RN
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Telephone | 620-378-3760
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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 | A103006H
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License Number State | KS
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