MEDICARE: MAYS PROFESSIONAL HOME HELATH OF SALLISAW, 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

General Provider Information

NPI Number	:	1689099426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYS PROFESSIONAL HOME HELATH OF SALLISAW, LLC

Provider Business Mailing Address
First Line	:	3310 LAMAR AVE
Second Line	:	SUITE A
City	:	PARIS
State	:	TX
Zip	:	75460-5024
Country	:	US
Telephone Number	:	903-905-4810
Fax Number	:	903-905-4812

Provider Business Practice Location Address
First Line	:	507 E REDWOOD AVE
Second Line	:
City	:	SALLISAW
State	:	OK
Zip	:	74955-3020
Country	:	US
Telephone Number	:	918-776-9400
Fax Number	:	918-776-9200

Authorized Official
Title or Position	:	CEO
Name	:	MR. ERIK DRENNEN
Credential	:
Telephone Number	:	903-905-4810

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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