Healthcare Provider Details

I. General information

NPI: 1265691968
Provider Name (Legal Business Name): MCCORTNEY FAMILY HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N MONTE VISTA ST
ADA OK
74820-7702
US

IV. Provider business mailing address

1018 N MONTE VISTA ST
ADA OK
74820-7702
US

V. Phone/Fax

Practice location:
  • Phone: 580-427-2273
  • Fax: 580-352-3577
Mailing address:
  • Phone: 580-427-2273
  • Fax: 580-352-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7875
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GREGORY MCCORTNEY
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 580-427-2273