MEDICARE: COMPANION HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	7790	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000377683001	OTHER	OK	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245233170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPANION HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	1310 E OKLAHOMA AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3757
Country	:	US
Telephone Number	:	405-293-9000
Fax Number	:	405-293-9001

Provider Business Practice Location Address
First Line	:	1310 E OKLAHOMA AVE
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3757
Country	:	US
Telephone Number	:	405-282-3402
Fax Number	:	405-282-3421

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DONNA BENNETT
Credential	:	RN, CHCA
Telephone Number	:	405-293-9000

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/15/2016

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Directions to “COMPANION HOME HEALTH, LLC ” Practice Location

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