Healthcare Provider Details

I. General information

NPI: 1821360769
Provider Name (Legal Business Name): COMPANION AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E OKLAHOMA AVE STE B
GUTHRIE OK
73044-3757
US

IV. Provider business mailing address

1310 E OKLAHOMA AVE STE B
GUTHRIE OK
73044-3757
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-1307
  • Fax: 405-282-3402
Mailing address:
  • Phone: 405-282-1307
  • Fax: 405-282-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7980
License Number StateOK

VIII. Authorized Official

Name: MS. DONNA K BENNETT
Title or Position: ADMINISTRATOR
Credential: R.N, CHCA
Phone: 405-282-1307