Healthcare Provider Details

I. General information

NPI: 1598389454
Provider Name (Legal Business Name): HOME AWAY FROM HOME ADULT DAY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9213 NE 10TH ST
MIDWEST CITY OK
73130-1317
US

IV. Provider business mailing address

9213 NE 10TH ST
MIDWEST CITY OK
73130-1317
US

V. Phone/Fax

Practice location:
  • Phone: 405-455-3342
  • Fax: 405-931-3204
Mailing address:
  • Phone: 405-455-3342
  • Fax: 405-931-3204

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: MISS KIMBERLY D RICHARDSON
Title or Position: DIRECTOR
Credential:
Phone: 405-264-7627