Healthcare Provider Details

I. General information

NPI: 1649083031
Provider Name (Legal Business Name): IN HOME 2 HEAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56296 E 285 RD STE A
AFTON OK
74331-8184
US

IV. Provider business mailing address

56296 E 285 RD STE A
AFTON OK
74331-8184
US

V. Phone/Fax

Practice location:
  • Phone: 918-219-9189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JANNA BAKER
Title or Position: CO-OWNER/VP CLINICAL OPERATIONS
Credential:
Phone: 620-778-5249