Provider Demographics
NPI:1669751814
Name:HOMETOWN QUALITY CARE, INC. I
Entity type:Organization
Organization Name:HOMETOWN QUALITY CARE, INC. I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN
Authorized Official - Phone:405-456-6902
Mailing Address - Street 1:1100 NE LINCOLN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-2412
Mailing Address - Country:US
Mailing Address - Phone:580-208-2273
Mailing Address - Fax:
Practice Address - Street 1:1100 NE LINCOLN RD
Practice Address - Street 2:SUITE D
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-2412
Practice Address - Country:US
Practice Address - Phone:580-208-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7965251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health