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General NPI Number Information
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NPI Number | 1699520858
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Entity Type | Organization
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Legal Business Name | HOMETOWN INCLUSIVE LIVING LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 2431 S 18TH ST
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-6976
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Country | US
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Telephone | 712-318-2324
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Fax |
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Provider Business Mailing Address
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Address Line | 5425 ELLISON AVE
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City | OMAHA
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State | NE
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Zip | 68104-1728
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | C0-OWNER
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Name | MR. JEREMY NASER
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Credential |
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Telephone | 712-318-2324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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