Healthcare Provider Details

I. General information

NPI: 1942535364
Provider Name (Legal Business Name): AT HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2009
Last Update Date: 12/23/2014
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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberCSS0009
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRENE O DAVIS
Title or Position: ADMINISTRATOR
Credential: CLINICIAN
Phone: 405-843-2333