Healthcare Provider Details

I. General information

NPI: 1114371739
Provider Name (Legal Business Name): WELCOME HOME ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SW 104TH ST
OKLAHOMA CITY OK
73139-2990
US

IV. Provider business mailing address

1000 SW 104TH ST
OKLAHOMA CITY OK
73139-2990
US

V. Phone/Fax

Practice location:
  • Phone: 405-692-1800
  • Fax: 405-692-1800
Mailing address:
  • Phone: 405-692-1800
  • Fax: 405-692-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC5514-5514
License Number StateOK

VIII. Authorized Official

Name: KARLA FORREST
Title or Position: OWNER
Credential: RN
Phone: 405-692-1800