Healthcare Provider Details

I. General information

NPI: 1639807167
Provider Name (Legal Business Name): P2G2 ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MAGNOLIA CT STE 209
MOORE OK
73160-1391
US

IV. Provider business mailing address

1111 MAGNOLIA CT STE 209
MOORE OK
73160-1391
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-4545
  • Fax: 405-504-6644
Mailing address:
  • Phone: 405-292-4545
  • Fax: 405-504-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GREGORY K JOHNSON
Title or Position: OWNER
Credential:
Phone: 405-292-4545