MEDICARE: HOMETOWN HAPPIER AT HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1932957222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN HAPPIER AT HOME LLC

Provider Business Mailing Address
First Line	:	4171 S OCEANA DR
Second Line	:
City	:	NEW ERA
State	:	MI
Zip	:	49446-9781
Country	:	US
Telephone Number	:	231-861-6900
Fax Number	:	231-861-7177

Provider Business Practice Location Address
First Line	:	4171 S OCEANA DR
Second Line	:
City	:	NEW ERA
State	:	MI
Zip	:	49446-9781
Country	:	US
Telephone Number	:	231-861-6900
Fax Number	:	231-861-7177

Authorized Official
Title or Position	:	VP OF ADMINISTRATION
Name	:	REBEKAH LYN DESARMO
Credential	:	PHARM D., MBA
Telephone Number	:	231-861-6902

Provider Enumeration Date	:	05/10/2024
Last Update Date	:	05/10/2024

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