MEDICARE: PENTADOYEN 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	7825	OK

General Provider Information

NPI Number	:	1336163013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENTADOYEN LLC

Provider Business Mailing Address
First Line	:	8241 S WALKER AVE
Second Line	:	SUITE 152
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9401
Country	:	US
Telephone Number	:	405-525-0118
Fax Number	:	405-525-3172

Provider Business Practice Location Address
First Line	:	8241 S WALKER AVE
Second Line	:	SUITE 152
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9401
Country	:	US
Telephone Number	:	405-525-0118
Fax Number	:	405-525-3172

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL L CHARBONEAU
Credential	:
Telephone Number	:	405-525-0118

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/25/2016

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