Healthcare Provider Details

I. General information

NPI: 1932351616
Provider Name (Legal Business Name): PATRIA HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W OKMULGEE AVE
CHECOTAH OK
74426-2413
US

IV. Provider business mailing address

3220 S PEORIA AVE STE 101
TULSA OK
74105-2006
US

V. Phone/Fax

Practice location:
  • Phone: 918-473-0505
  • Fax: 918-473-0705
Mailing address:
  • Phone: 918-770-4441
  • Fax: 918-712-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7833
License Number StateOK

VIII. Authorized Official

Name: SHERRY J CROCKETT
Title or Position: ADMINISTRATOR
Credential: BA, LPN
Phone: 918-633-6229