Provider Demographics
NPI:1386079648
Name:HOMEBASED SERVICES AND RESOURCES
Entity type:Organization
Organization Name:HOMEBASED SERVICES AND RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LADC
Authorized Official - Phone:918-694-1999
Mailing Address - Street 1:904 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1652
Mailing Address - Country:US
Mailing Address - Phone:918-967-8223
Mailing Address - Fax:
Practice Address - Street 1:904 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1652
Practice Address - Country:US
Practice Address - Phone:918-967-8223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health