Healthcare Provider Details

I. General information

NPI: 1104036748
Provider Name (Legal Business Name): COMPREHENSIVE PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 COTTONWOOD STREET
STRATFORD OK
74872-0636
US

IV. Provider business mailing address

PO BOX 636
STRATFORD OK
74872-0636
US

V. Phone/Fax

Practice location:
  • Phone: 580-759-2313
  • Fax: 580-759-3567
Mailing address:
  • Phone: 580-759-2313
  • Fax: 580-759-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberOKNH2505
License Number StateOK

VIII. Authorized Official

Name: MRS. SHAUNA GRAVES
Title or Position: OWNER
Credential:
Phone: 580-592-4953