Healthcare Provider Details

I. General information

NPI: 1780505248
Provider Name (Legal Business Name): NORTH CANADIAN RIVER HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 S BROADWAY STE 231 OFFICE 237
EDMOND OK
73013-4063
US

IV. Provider business mailing address

3209 S BROADWAY STE 231
EDMOND OK
73013-4063
US

V. Phone/Fax

Practice location:
  • Phone: 572-201-0020
  • Fax:
Mailing address:
  • Phone: 572-201-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN NICHOLS
Title or Position: DIRECTOR- HOME CARE ADMINISTRATOR
Credential:
Phone: 572-205-7881