Healthcare Provider Details

I. General information

NPI: 1124870464
Provider Name (Legal Business Name): LORETTAS ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 NW 170 TH EDMOND
EDMOND OKLAHOMA 73012 OK
73034
US

IV. Provider business mailing address

3027 WILLOWOOD RD
EDMOND OK
73034-9725
US

V. Phone/Fax

Practice location:
  • Phone: 405-994-4209
  • Fax:
Mailing address:
  • Phone: 405-992-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LORETTA THOMAS
Title or Position: OWNER
Credential:
Phone: 405-992-4209