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General NPI Number Information
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NPI Number | 1124870464
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Entity Type | Organization
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Legal Business Name | LORETTAS ADULT DAYCARE INC
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 1404 NW 170 TH EDMOND
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City | EDMOND OKLAHOMA 73012
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State | OK
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Zip | 73034
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Country | US
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Telephone | 405-994-4209
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Fax |
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Provider Business Mailing Address
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Address Line | 3027 WILLOWOOD RD
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City | EDMOND
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State | OK
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Zip | 73034-9725
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Country | US
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Telephone | 405-992-4209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORETTA THOMAS
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Credential |
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Telephone | 405-992-4209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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