MEDICARE: HOMETOWN HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689678385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	1569 MALLORY LN BLDG 100
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2872
Country	:	US
Telephone Number	:	615-921-7054
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 SALEM CHURCH RD
Second Line	:
City	:	JASPER
State	:	GA
Zip	:	30143
Country	:	US
Telephone Number	:	706-253-1620
Fax Number	:	706-253-1621

Authorized Official
Title or Position	:	CEO
Name	:	MR. LUKE MCGEE
Credential	:
Telephone Number	:	646-880-0473

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/28/2018

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