Healthcare Provider Details

I. General information

NPI: 1548175599
Provider Name (Legal Business Name): RUSTIC HEALTH HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 N 117TH EAST AVE STE 106
OWASSO OK
74055-2192
US

IV. Provider business mailing address

8555 N 117TH EAST AVE STE 106
OWASSO OK
74055-2192
US

V. Phone/Fax

Practice location:
  • Phone: 539-476-2299
  • Fax: 575-205-0274
Mailing address:
  • Phone: 539-476-2299
  • Fax: 575-205-0274

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: REBECCA R CARTER
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 539-476-2299