Healthcare Provider Details

I. General information

NPI: 1831226075
Provider Name (Legal Business Name): ULTIMATE HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 259 SOUTH
IDABEL OK
74745
US

IV. Provider business mailing address

HIGHWAY 259 SOUTH
IDABEL OK
74745
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2537
  • Fax: 580-286-5480
Mailing address:
  • Phone: 580-286-2537
  • Fax: 580-286-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7496
License Number StateOK

VIII. Authorized Official

Name: MR. WILLIAM E. DAVES JR.
Title or Position: MANAGING MEMBER AND PRESIDENT
Credential:
Phone: 580-286-2537