Provider Demographics
NPI:1093926149
Name:SPECIALIZED FOSTER HOME
Entity type:Organization
Organization Name:SPECIALIZED FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZOELLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-775-2628
Mailing Address - Street 1:RR 1 BOX 112A
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9737
Mailing Address - Country:US
Mailing Address - Phone:918-775-2628
Mailing Address - Fax:918-775-2628
Practice Address - Street 1:RR 1 BOX 112A
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9737
Practice Address - Country:US
Practice Address - Phone:918-775-2628
Practice Address - Fax:918-775-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty