Provider Demographics
NPI:1598389454
Name:HOME AWAY FROM HOME ADULT DAY SERVICES LLC
Entity Type:Organization
Organization Name:HOME AWAY FROM HOME ADULT DAY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-264-7627
Mailing Address - Street 1:9213 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-1317
Mailing Address - Country:US
Mailing Address - Phone:405-455-3342
Mailing Address - Fax:405-931-3204
Practice Address - Street 1:9213 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-1317
Practice Address - Country:US
Practice Address - Phone:405-455-3342
Practice Address - Fax:405-931-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care