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General NPI Number Information
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NPI Number | 1720901994
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Entity Type | Organization
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Legal Business Name | HOME AWAY FROM HOME BEHAVIORAL HEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 9213 NE 10TH ST
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City | MIDWEST CITY
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State | OK
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Zip | 73130-1317
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Country | US
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Telephone | 405-455-3342
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Fax | 405-931-3204
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Provider Business Mailing Address
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Address Line | 9213 NE 10TH ST
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City | MIDWEST CITY
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State | OK
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Zip | 73130-1317
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Country | US
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Telephone | 405-455-3342
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Fax | 405-931-3204
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIMBERLY RICHARDSON
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Credential | ADHC
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Telephone | 405-455-3342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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