Healthcare Provider Details

I. General information

NPI: 1366015216
Provider Name (Legal Business Name): TIMOTHY HAYES ADMINISTRATOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 E 53RD ST # 132
TULSA OK
74135-4050
US

IV. Provider business mailing address

4515 E 53RD ST # 132
TULSA OK
74135-4050
US

V. Phone/Fax

Practice location:
  • Phone: 918-430-3088
  • Fax:
Mailing address:
  • Phone: 918-430-3088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberCSS0800
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCSS0800
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberCSS0800
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCSS0800
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: