Healthcare Provider Details

I. General information

NPI: 1053319582
Provider Name (Legal Business Name): CHEROKEE NATION HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 N CEDAR AVE
TAHLEQUAH OK
74464-6755
US

IV. Provider business mailing address

1630 N CEDAR AVE
TAHLEQUAH OK
74464-6755
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-6102
  • Fax: 918-456-5192
Mailing address:
  • Phone: 918-458-6102
  • Fax: 918-456-5192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7258
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MATTHEW RUCKER
Title or Position: CEO
Credential:
Phone: 918-456-5051