Healthcare Provider Details

I. General information

NPI: 1124073432
Provider Name (Legal Business Name): SISTERLY CARE HEALTH SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W MAIN ST
TISHOMINGO OK
73460-1733
US

IV. Provider business mailing address

708 W MAIN ST
TISHOMINGO OK
73460-1733
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-9300
  • Fax: 580-371-2923
Mailing address:
  • Phone: 580-371-9300
  • Fax: 580-371-2923

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: MRS. TRACY DAWN PARKS
Title or Position: CHIEF OPERATIONAL OFFICER/OWNER
Credential:
Phone: 580-371-9300