Healthcare Provider Details

I. General information

NPI: 1235457326
Provider Name (Legal Business Name): HOMETOWN SPECIAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W WILSHIRE BLVD STE 351
OKLAHOMA CITY OK
73116-7030
US

IV. Provider business mailing address

1000 W WILSHIRE BLVD STE 351
OKLAHOMA CITY OK
73116-7030
US

V. Phone/Fax

Practice location:
  • Phone: 405-418-2972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7944
License Number StateOK

VIII. Authorized Official

Name: LARRY J COFFMAN SR.
Title or Position: PRESIDENT
Credential:
Phone: 405-706-4988