Healthcare Provider Details

I. General information

NPI: 1326289356
Provider Name (Legal Business Name): BONNY CREST HOME HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2009
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W FORT WORTH ST
BROKEN ARROW OK
74012-3719
US

IV. Provider business mailing address

700 W FORT WORTH ST
BROKEN ARROW OK
74012-3719
US

V. Phone/Fax

Practice location:
  • Phone: 918-949-4555
  • Fax: 918-933-5352
Mailing address:
  • Phone: 918-949-4555
  • Fax: 918-933-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHAKAKHAN L JONES
Title or Position: ADMINISTRATOR
Credential: BA, BS
Phone: 918-949-4555