Healthcare Provider Details

I. General information

NPI: 1194234864
Provider Name (Legal Business Name): SAND LILY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S BROADWAY
EDMOND OK
73013-4021
US

IV. Provider business mailing address

2120 S BROADWAY
EDMOND OK
73013-4021
US

V. Phone/Fax

Practice location:
  • Phone: 405-639-3939
  • Fax: 405-639-2079
Mailing address:
  • Phone: 405-639-3939
  • Fax: 405-639-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AMBER L TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726