Healthcare Provider Details

I. General information

NPI: 1548507072
Provider Name (Legal Business Name): MCCORTNEY FAMILY HOME HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 05/22/2019
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
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number7875
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY MCCORTNEY
Title or Position: PRESIDENT
Credential:
Phone: 580-427-2273