Healthcare Provider Details

I. General information

NPI: 1417401761
Provider Name (Legal Business Name): JEY & ASSOCIATES, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12017 DAHOON DR
OKLAHOMA CITY OK
73120-8131
US

IV. Provider business mailing address

12017 DAHOON DR
OKLAHOMA CITY OK
73120-8131
US

V. Phone/Fax

Practice location:
  • Phone: 405-313-8685
  • Fax: 877-719-2739
Mailing address:
  • Phone: 405-313-8685
  • Fax: 877-719-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number37V261041204
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number37V261041204
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number37H041801211
License Number StateOK

VIII. Authorized Official

Name: MRS. GENNICE JENAIL WILLIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-313-8685