Healthcare Provider Details

I. General information

NPI: 1245269224
Provider Name (Legal Business Name): PRIME HOME HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N MACARTHUR BLVD STE.116
OKLAHOMA CITY OK
73127-2617
US

IV. Provider business mailing address

1900 N MACARTHUR BLVD STE.116
OKLAHOMA CITY OK
73127-2617
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-3826
  • Fax: 405-601-0948
Mailing address:
  • Phone: 405-601-3826
  • Fax: 405-601-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IKETA DANSHEA DAWKINS
Title or Position: CEO
Credential:
Phone: 405-601-3826