Healthcare Provider Details

I. General information

NPI: 1770557910
Provider Name (Legal Business Name): RESTORE HOME HEALTHCARE OF OKLAHOMA ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W URBANA ST STE 200
BROKEN ARROW OK
74012-5520
US

IV. Provider business mailing address

6760 OLD JACKSONVILLE HWY STE 101
TYLER TX
75703-0566
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-9172
  • Fax: 800-590-6996
Mailing address:
  • Phone: 855-485-8273
  • Fax: 888-333-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7053
License Number StateOK

VIII. Authorized Official

Name: KATRINA DAWN LANIER
Title or Position: CGO
Credential:
Phone: 855-485-8273