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General NPI Number Information
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NPI Number | 1568957348
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Entity Type | Organization
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Legal Business Name | HOME RUN HEALTHCARE
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 1425 EAST LINCOLN ROAD SUITE A-3
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City | IDABEL
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State | OK
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Zip | 74745
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Country | US
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Telephone | 580-212-7237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51
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City | GARVIN
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State | OK
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Zip | 74736-0051
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Country | US
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Telephone | 580-212-7237
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASHLEI JOBE
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Credential | NURSE PRACTIONER
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Telephone | 580-212-7237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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