Healthcare Provider Details

I. General information

NPI: 1558716084
Provider Name (Legal Business Name): OK4 HOME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S YORK ST
MUSKOGEE OK
74403-8876
US

IV. Provider business mailing address

2303 S YORK ST
MUSKOGEE OK
74403-8876
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-6400
  • Fax:
Mailing address:
  • Phone: 918-682-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISAAC DOLE
Title or Position: MANAGER/PRINCIPAL
Credential:
Phone: 773-645-9246