Healthcare Provider Details

I. General information

NPI: 1194605998
Provider Name (Legal Business Name): CIRCLE OF LIFE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8524 S WESTERN AVE STE 109
OKLAHOMA CITY OK
73139-9247
US

IV. Provider business mailing address

8524 S WESTERN AVE STE 109
OKLAHOMA CITY OK
73139-9247
US

V. Phone/Fax

Practice location:
  • Phone: 405-915-7243
  • Fax:
Mailing address:
  • Phone: 405-915-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL E OVERLEY
Title or Position: OWNER
Credential: ADMIN
Phone: 405-915-7245