MEDICARE: PPD 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427641398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PPD HEALTH, LLC

Provider Business Mailing Address
First Line	:	2831 NW 59TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7005
Country	:	US
Telephone Number	:	405-602-3295
Fax Number	:	405-602-3297

Provider Business Practice Location Address
First Line	:	2831 NW 59TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7005
Country	:	US
Telephone Number	:	405-602-3295
Fax Number	:	405-602-3297

Authorized Official
Title or Position	:	PERSONAL CARE DIRECTOR
Name	:	JEREMY ALLEN
Credential	:
Telephone Number	:	405-992-0570

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	02/11/2021

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