Healthcare Provider Details

I. General information

NPI: 1619115896
Provider Name (Legal Business Name): ACCENTRA HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S 7TH ST STE 400
KINGFISHER OK
73750-4318
US

IV. Provider business mailing address

6760 OLD JACKSONVILLE HWY # 500
TYLER TX
75703-0572
US

V. Phone/Fax

Practice location:
  • Phone: 888-640-3907
  • Fax:
Mailing address:
  • Phone: 855-485-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251E00000X
License Number StateOK

VIII. Authorized Official

Name: MR. KATRINA LANIER
Title or Position: SECRETARY
Credential:
Phone: 855-485-8273