Healthcare Provider Details

I. General information

NPI: 1376798298
Provider Name (Legal Business Name): WHEATHEART NUTRITION PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N MAIN ST
BLACKWELL OK
74631-2226
US

IV. Provider business mailing address

123 N MAIN ST PO BOX 606
BLACKWELL OK
74631-2226
US

V. Phone/Fax

Practice location:
  • Phone: 580-262-0303
  • Fax: 580-262-0301
Mailing address:
  • Phone: 580-262-0303
  • Fax: 580-262-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateOK

VIII. Authorized Official

Name: MRS. KATHLEEN M WILLIS
Title or Position: PROJECT DIRECTOR
Credential:
Phone: 580-262-0303