Healthcare Provider Details

I. General information

NPI: 1871179754
Provider Name (Legal Business Name): CENTRAL OKLAHOMA HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S BROADWAY STE 310
EDMOND OK
73013-4046
US

IV. Provider business mailing address

PO BOX 8175
WACO TX
76714-8175
US

V. Phone/Fax

Practice location:
  • Phone: 405-227-9899
  • Fax:
Mailing address:
  • Phone: 254-265-6711
  • Fax:

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: COREY LEE WATSON
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 409-938-6896