1629213889 NPI number — HOMETOWN QUALITY CARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629213889 NPI number — HOMETOWN QUALITY CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMETOWN QUALITY CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACCENTRA HOME HEALTH - SOUTHEASTERN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629213889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2028 E MEMORIAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-5515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-840-7775
Provider Business Mailing Address Fax Number:
405-840-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191475 N 4140 RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTLERS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74523-7587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-298-2000
Provider Business Practice Location Address Fax Number:
580-298-2001
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BEARD
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
CCO
Authorized Official Telephone Number:
405-840-7775

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7899 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200391290A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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