Provider Demographics
NPI:1043428022
Name:HOMETOWN MEDICAL & REHAB
Entity type:Organization
Organization Name:HOMETOWN MEDICAL & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-423-6909
Mailing Address - Street 1:740 FRONT ST STE 170
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4536
Mailing Address - Country:US
Mailing Address - Phone:831-423-6909
Mailing Address - Fax:831-423-6900
Practice Address - Street 1:740 FRONT ST STE 170
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4536
Practice Address - Country:US
Practice Address - Phone:831-423-6909
Practice Address - Fax:831-423-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASR GHC 102 062635OtherSELLERS PERMIT