Healthcare Provider Details

I. General information

NPI: 1811314727
Provider Name (Legal Business Name): HEALTHCARE INNOVATION IN-HOME SERVICES V, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MERRICK DR BLDG B3B
ARDMORE OK
73401-1824
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY STE 1100
DALLAS TX
75234-2712
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-9984
  • Fax: 405-949-0121
Mailing address:
  • Phone: 800-379-1600
  • Fax: 903-537-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7758
License Number StateOK

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: SENIOR VICE PRESIDENT OF COMPLIANCE
Credential:
Phone: 800-379-1600