Healthcare Provider Details

I. General information

NPI: 1710985080
Provider Name (Legal Business Name): CHEROKEE NATION HOME HEALTH OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
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: 918-456-5051
  • Fax: 918-456-1120
Mailing address:
  • Phone: 918-456-5051
  • Fax: 918-456-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number7671
License Number StateOK

VII. Legacy identifiers

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

VIII. Authorized Official

Name: APRIL MOORE
Title or Position: CEO
Credential:
Phone: 918-456-5051