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General NPI Number Information
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NPI Number | 1912111253
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Entity Type | Organization
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Legal Business Name | HOMESTEAD RESIDENTIAL CARE
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 35284 S 4440 RD
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City | VINITA
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State | OK
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Zip | 74301-7079
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Country | US
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Telephone | 918-527-7462
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 554
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City | VINITA
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State | OK
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Zip | 74301-0554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. DONNA KELLEY
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Credential |
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Telephone | 918-782-9969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RC1811-1811
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License Number State | OK
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