Healthcare Provider Details

I. General information

NPI: 1245579952
Provider Name (Legal Business Name): UNITED PARTNERS HEALTHCARE 2, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 WEST MAIN STREET
STIGLER OK
74462
US

IV. Provider business mailing address

1000 NE 8TH STREET
STIGLER OK
74462
US

V. Phone/Fax

Practice location:
  • Phone: 918-967-2593
  • Fax: 918-967-4707
Mailing address:
  • Phone: 918-967-2593
  • Fax: 918-967-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number8007
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8007
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number8007
License Number StateOK

VIII. Authorized Official

Name: TREASA LASSITER
Title or Position: RN/ADMINISTRATOR
Credential:
Phone: 918-617-3056