Healthcare Provider Details

I. General information

NPI: 1982905436
Provider Name (Legal Business Name): PROVIDENCE EXCEL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 S SHERIDAN RD STE 502
TULSA OK
74145-5719
US

IV. Provider business mailing address

4845 S SHERIDAN RD STE 502
TULSA OK
74145-5719
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-4334
  • Fax: 918-794-4344
Mailing address:
  • Phone: 918-794-4334
  • Fax: 918-794-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberCSS0016
License Number StateOK

VIII. Authorized Official

Name: MR. AMOS O. ADESOKAN
Title or Position: ADMINISTRATOR
Credential: RN BSN
Phone: 918-625-4797