Healthcare Provider Details

I. General information

NPI: 1093739120
Provider Name (Legal Business Name): INTEGRIS BLACKWELL HOME HEALTH & HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S 13TH ST
BLACKWELL OK
74631-3700
US

IV. Provider business mailing address

706 S 13TH STREET
BLACKWELL OK
74631-3700
US

V. Phone/Fax

Practice location:
  • Phone: 580-363-2311
  • Fax: 580-363-9352
Mailing address:
  • Phone: 580-363-2311
  • Fax: 580-363-9352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7335
License Number StateOK

VIII. Authorized Official

Name: LAURIE J HOLTSFORD
Title or Position: DIRECTOR, BUSINESS OPERATIONS
Credential:
Phone: 615-465-7466