Provider Demographics
NPI:1225179500
Name:HOME OF HOPE, INC./WOODLOE
Entity Type:Organization
Organization Name:HOME OF HOPE, INC./WOODLOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SVEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-256-7825
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0903
Mailing Address - Country:US
Mailing Address - Phone:918-256-7825
Mailing Address - Fax:
Practice Address - Street 1:960 WEST HOPE AVENUE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301
Practice Address - Country:US
Practice Address - Phone:918-256-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100772430BMedicaid