Healthcare Provider Details

I. General information

NPI: 1689099426
Provider Name (Legal Business Name): MAYS PROFESSIONAL HOME HELATH OF SALLISAW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E REDWOOD AVE
SALLISAW OK
74955-3020
US

IV. Provider business mailing address

3310 LAMAR AVE SUITE A
PARIS TX
75460-5024
US

V. Phone/Fax

Practice location:
  • Phone: 918-776-9400
  • Fax: 918-776-9200
Mailing address:
  • Phone: 903-905-4810
  • Fax: 903-905-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIK DRENNEN
Title or Position: CEO
Credential:
Phone: 903-905-4810