Healthcare Provider Details

I. General information

NPI: 1538561121
Provider Name (Legal Business Name): 1ST PRIME HOME HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N MACARTHUR BLVD
OKLAHOMA CITY OK
73127-2617
US

IV. Provider business mailing address

1900 N. MACARTHUR BLVD SUITE 116
OKLAHOMA CITY OK
73127-0000
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-6542
  • Fax: 405-601-0948
Mailing address:
  • Phone: 405-822-6542
  • Fax: 405-601-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7831
License Number StateOK

VIII. Authorized Official

Name: RICHARD DOUGLAS
Title or Position: OWNER
Credential:
Phone: 405-822-6542