1184941346 NPI number — HOMETOWN HEALTHCARE LLC

Table of content: (NPI 1184941346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184941346 NPI number — HOMETOWN HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMETOWN HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GARFIELD MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184941346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 2070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE GROVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78372-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-879-2279
Provider Business Mailing Address Fax Number:
830-879-2235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 E SAN MARCOS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARSALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78061-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-334-3336
Provider Business Practice Location Address Fax Number:
830-334-5574
Provider Enumeration Date:
04/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
WILL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-879-2279

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  PA04256 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 281495602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281495601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".