Healthcare Provider Details

I. General information

NPI: 1306883723
Provider Name (Legal Business Name): BARTLESVILLE COMPANION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 SE NOWATA ROAD SUITE D
BARTLESVILLE OK
74006-5039
US

IV. Provider business mailing address

1025 SWAN DR 455
BARTLESVILLE OK
74006-5039
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-4200
  • Fax: 918-333-5945
Mailing address:
  • Phone: 918-333-4299
  • Fax: 918-333-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7633
License Number StateOK

VIII. Authorized Official

Name: MRS. ELIZABETH ANN COLLINS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 918-333-4200