Healthcare Provider Details

I. General information

NPI: 1346229226
Provider Name (Legal Business Name): CREATIVE HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 N BROADWAY ST
POTEAU OK
74953-5403
US

IV. Provider business mailing address

PO BOX 297
POTEAU OK
74953-0297
US

V. Phone/Fax

Practice location:
  • Phone: 918-647-8691
  • Fax:
Mailing address:
  • Phone: 918-647-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7331
License Number StateOK

VIII. Authorized Official

Name: MS. REBECCA COFFMAN
Title or Position: PRESIDENT
Credential:
Phone: 918-647-8691