Provider Demographics
NPI:1992448740
Name:2ND HOME ADULT DAYCARE, LLC
Entity type:Organization
Organization Name:2ND HOME ADULT DAYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-494-5700
Mailing Address - Street 1:2006 W WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2401
Mailing Address - Country:US
Mailing Address - Phone:580-297-4034
Mailing Address - Fax:580-324-6245
Practice Address - Street 1:2006 W WILLOW RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2401
Practice Address - Country:US
Practice Address - Phone:580-297-4034
Practice Address - Fax:580-324-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care