Healthcare Provider Details

I. General information

NPI: 1104830421
Provider Name (Legal Business Name): PHOENIX HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 N IROQUOIS AVE
TULSA OK
74106-4407
US

IV. Provider business mailing address

1944 N IROQUOIS AVE
TULSA OK
74106-4407
US

V. Phone/Fax

Practice location:
  • Phone: 918-583-1509
  • Fax: 918-583-1804
Mailing address:
  • Phone: 918-583-1509
  • Fax: 918-583-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7221
License Number StateOK

VIII. Authorized Official

Name: ANGELA MATTHEWS
Title or Position: MEDICARE SPECIALIST
Credential:
Phone: 918-743-3638