Healthcare Provider Details

I. General information

NPI: 1114932639
Provider Name (Legal Business Name): INDIAN TERRITORY HOME HEALTH & HOSPICE II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 W GORE BLVD STE B
LAWTON OK
73505
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY STE 1100
DALLAS TX
75234-2712
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7473
  • Fax: 580-931-6920
Mailing address:
  • Phone: 800-379-1600
  • Fax: 903-537-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number100262450A
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7745
License Number StateOK

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: COMPLIANCE,PRIVACY,& SAFETY OFFICER
Credential:
Phone: 517-768-4373