Healthcare Provider Details

I. General information

NPI: 1154632537
Provider Name (Legal Business Name): OKLAHOMA HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N MAIN ST
FAIRFAX OK
74637-3022
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 918-642-5383
  • Fax: 918-642-3531
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

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: PETER C NOVEMBER II
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 337-233-1307