# HOMETOWN MEDICAL SUPPLIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619660149
- **Authorized official:** KILEY ANN RUSSELL (SENIOR DIRECTOR OF PAYOR RELATIONS)
- **Authorized official phone:** (629) 252-8211

## Contact information

- **Practice address:** 10700 JERSEY BLVD STE 190, RANCHO CUCAMONGA, CA 91730-5127
- **Practice address phone:** (909) 906-0962
- **Practice address fax:** (909) 966-4699
- **Mailing address:** 9495 WINNETKA AVE N STE 200, BROOKLYN PARK, MN 55445-1618
- **Mailing address phone:** (629) 252-8211
- **Mailing address fax:** (763) 255-3972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 05/31/2023
- **Last updated:** 04/17/2024