Hometown Medical Supplies LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

HOMETOWN MEDICAL SUPPLIES LLC

Practice address

10700 Jersey Blvd Ste 190
Rancho Cucamonga, CA 91730-5127

Phone

(909) 906-0962

Fax

(909) 966-4699

NPI assigned

May 31, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kiley Ann Russell

Title

Senior Director of Payor Relations

Phone

(629) 252-8211

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1619660149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9495 WINNETKA AVE N STE 200",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554451618",
            "telephone_number": "629-252-8211",
            "fax_number": "763-255-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 JERSEY BLVD STE 190",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305127",
            "telephone_number": "909-906-0962",
            "fax_number": "909-966-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMETOWN MEDICAL SUPPLIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-31",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "KILEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "SENIOR DIRECTOR OF PAYOR RELATIONS",
        "authorized_official_telephone_number": "629-252-8211"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.