MEDICARE: RESTORE HOME HEALTHCARE OF OKLAHOMA ,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	7053	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HC7051	OTHER	OK	OKLAHOMA STATE DEPARTMENT OF HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	731398584016	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770557910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE HOME HEALTHCARE OF OKLAHOMA ,LLC

Provider Business Mailing Address
First Line	:	6760 OLD JACKSONVILLE HWY STE 101
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0566
Country	:	US
Telephone Number	:	855-485-8273
Fax Number	:	888-333-8977

Provider Business Practice Location Address
First Line	:	4700 W URBANA ST STE 200
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5520
Country	:	US
Telephone Number	:	918-682-9172
Fax Number	:	800-590-6996

Authorized Official
Title or Position	:	CGO
Name	:	KATRINA DAWN LANIER
Credential	:
Telephone Number	:	855-485-8273

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/28/2025

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Directions to “RESTORE HOME HEALTHCARE OF OKLAHOMA ,LLC ” Practice Location

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