Provider Demographics
NPI:1730988155
Name:HOMETOWN BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:HOMETOWN BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:907-433-9358
Mailing Address - Street 1:23914 THE CLEARING DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9659
Mailing Address - Country:US
Mailing Address - Phone:907-433-9358
Mailing Address - Fax:
Practice Address - Street 1:505 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2552
Practice Address - Country:US
Practice Address - Phone:907-433-9358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty