Healthcare Provider Details

I. General information

NPI: 1831191543
Provider Name (Legal Business Name): OMH HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MORRIS DRIVE
OKMULGEE OK
74447-6429
US

IV. Provider business mailing address

PO BOX 1038
OKMULGEE OK
74447-1038
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-4233
  • Fax: 918-756-5968
Mailing address:
  • Phone: 918-756-4233
  • Fax: 918-756-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7077
License Number StateOK

VIII. Authorized Official

Name: MRS. SHARON RIKER
Title or Position: DIRECTOR/IT
Credential:
Phone: 918-756-4233