=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669119855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMETOWN TRANSPORTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2022
-----------------------------------------------------
Last Update Date | 10/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 00650 LIETTE LN
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45885-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-962-9405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 00650 LIETTE LN
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45885-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-962-9405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | STEPHANIE RENEE MILLER
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 419-962-9405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------