MEDICARE: COMPANION AT HOME, 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	7980	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7980	OTHER	OK	STATE LICENSE

General Provider Information

NPI Number	:	1821360769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPANION AT HOME, LLC

Provider Business Mailing Address
First Line	:	1310 E OKLAHOMA AVE STE B
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3757
Country	:	US
Telephone Number	:	405-282-1307
Fax Number	:	405-282-3402

Provider Business Practice Location Address
First Line	:	1310 E OKLAHOMA AVE STE B
Second Line	:
City	:	GUTHRIE
State	:	OK
Zip	:	73044-3757
Country	:	US
Telephone Number	:	405-282-1307
Fax Number	:	405-282-3402

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DONNA K BENNETT
Credential	:	R.N, CHCA
Telephone Number	:	405-282-1307

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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Directions to “COMPANION AT HOME, LLC ” Practice Location

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