Provider Demographics
NPI:1568957348
Name:HOME RUN HEALTHCARE
Entity Type:Organization
Organization Name:HOME RUN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTIONER
Authorized Official - Phone:580-212-7237
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:GARVIN
Mailing Address - State:OK
Mailing Address - Zip Code:74736-0051
Mailing Address - Country:US
Mailing Address - Phone:580-212-7237
Mailing Address - Fax:
Practice Address - Street 1:1425 EAST LINCOLN ROAD
Practice Address - Street 2:SUITE A-3
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745
Practice Address - Country:US
Practice Address - Phone:580-212-7237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1679013676Medicaid