Healthcare Provider Details

I. General information

NPI: 1700107828
Provider Name (Legal Business Name): ;HOME SWEET HOME ASSISTED CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 WEST HWY 152
MUSTANG OK
73064
US

IV. Provider business mailing address

1017 WEST HWY 152
MUSTANG OK
73064
US

V. Phone/Fax

Practice location:
  • Phone: 918-902-6621
  • Fax: 918-334-5581
Mailing address:
  • Phone: 918-902-6621
  • Fax: 918-334-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN A SHEAY
Title or Position: OWNER
Credential:
Phone: 918-902-6621