Healthcare Provider Details

I. General information

NPI: 1649688391
Provider Name (Legal Business Name): OUTREACH HEALTH SERVICES OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302B SW LEE BLVD
LAWTON OK
73501-5610
US

IV. Provider business mailing address

251 RENNER PKWY
RICHARDSON TX
75080-1316
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-1870
  • Fax: 580-355-1877
Mailing address:
  • Phone: 512-692-7839
  • Fax: 972-792-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: REBECCA WILLIAMS
Title or Position: CORPORATE LEGAL MANAGER
Credential:
Phone: 512-692-7839