Healthcare Provider Details

I. General information

NPI: 1710026299
Provider Name (Legal Business Name): FORT SMITH HMA HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307B E RAY FINE BLVD
ROLAND OK
74954-5160
US

IV. Provider business mailing address

307B E RAY FINE BLVD
ROLAND OK
74954-5160
US

V. Phone/Fax

Practice location:
  • Phone: 918-427-9773
  • Fax: 918-427-6021
Mailing address:
  • Phone: 918-427-9773
  • Fax: 918-427-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7115
License Number StateOK

VIII. Authorized Official

Name: MS. LAURIE J HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 61546574566