MEDICARE: HOMETOWN RESPITE, INC.

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1952049165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN RESPITE, INC.

Provider Business Mailing Address
First Line	:	534 CHATFIELD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-1710
Country	:	US
Telephone Number	:	719-648-7532
Fax Number	:	719-634-8535

Provider Business Practice Location Address
First Line	:	320 S CASCADE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3814
Country	:	US
Telephone Number	:	719-648-7532
Fax Number	:	719-634-8535

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ALEX DARIN KERR
Credential	:	ESQUIRE
Telephone Number	:	719-648-7532

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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