Healthcare Provider Details

I. General information

NPI: 1659897031
Provider Name (Legal Business Name): KATIE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E EUFAULA ST STE 220
NORMAN OK
73069-6080
US

IV. Provider business mailing address

222 E EUFAULA ST STE 220
NORMAN OK
73069-6080
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-2756
  • Fax: 405-310-2753
Mailing address:
  • Phone: 405-310-2756
  • Fax: 405-310-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberWC7883
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberWC7883
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberWC7883
License Number StateOK

VIII. Authorized Official

Name: HAROLD KEITH MAHONEY
Title or Position: OWNER/MANAGER
Credential:
Phone: 405-310-2756