Healthcare Provider Details

I. General information

NPI: 1396819660
Provider Name (Legal Business Name): HCIPS IN-HOME SERVICES OF HUGO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W JACKSON
HUGO OK
74743-3342
US

IV. Provider business mailing address

303 W JACKSON
HUGO OK
74743-3342
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-6877
  • Fax: 580-326-7775
Mailing address:
  • Phone: 580-326-6877
  • Fax: 580-326-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7086
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number7086
License Number StateOK

VIII. Authorized Official

Name: LOLA JANE EDWARDS
Title or Position: PRESIDENT
Credential: RN
Phone: 918-360-7014