Healthcare Provider Details

I. General information

NPI: 1457170417
Provider Name (Legal Business Name): OKC HOME CARE HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 NW EXPRESSWAY STE 107W
OKLAHOMA CITY OK
73112-7201
US

IV. Provider business mailing address

2601 NW EXPRESSWAY STE 107W
OKLAHOMA CITY OK
73112-7201
US

V. Phone/Fax

Practice location:
  • Phone: 405-753-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SCOTT VAN DUINEN
Title or Position: PRESIDENT
Credential:
Phone: 405-242-5300