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General NPI Number Information
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NPI Number | 1366622003
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Entity Type | Organization
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Legal Business Name | HER IN HOME VISITS PLLC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 800 N REFORMATORY RD
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City | EL RENO
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State | OK
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Zip | 73036-2004
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Country | US
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Telephone | 405-262-7920
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Fax |
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Provider Business Mailing Address
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Address Line | 800 N REFORMATORY RD
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City | EL RENO
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State | OK
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Zip | 73036-2004
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Country | US
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Telephone | 405-262-7920
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JERRY SUE COLBERT
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Credential | RN
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Telephone | 405-262-7920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R0044326
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0044326
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License Number State | OK
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