Healthcare Provider Details

I. General information

NPI: 1063733129
Provider Name (Legal Business Name): AT HOME CARE HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N CLASSEN BLVD STE 108
OKLAHOMA CITY OK
73106-6011
US

IV. Provider business mailing address

PO BOX 5961
EDMOND OK
73083-5961
US

V. Phone/Fax

Practice location:
  • Phone: 405-843-2333
  • Fax: 405-843-2344
Mailing address:
  • Phone: 405-843-2333
  • Fax: 405-843-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberHC7947
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberHC7947
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC7947
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberHC7947
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC7947
License Number StateOK
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC7947
License Number StateOK

VIII. Authorized Official

Name: MRS. IRENE O DAVIS
Title or Position: ADMINISTRATOR/CEO
Credential: GERONTOLOGIST, MS
Phone: 405-843-2333