Healthcare Provider Details

I. General information

NPI: 1669384756
Provider Name (Legal Business Name): AUGUST R HOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SE 4TH ST
MOORE OK
73160-7329
US

IV. Provider business mailing address

27831 FAIR HILL RD
CAMERON OK
74932-2391
US

V. Phone/Fax

Practice location:
  • Phone: 405-837-1033
  • Fax:
Mailing address:
  • Phone: 918-413-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: