Healthcare Provider Details

I. General information

NPI: 1497708713
Provider Name (Legal Business Name): WOODWARD HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 MAIN ST SUITE 103
WOODWARD OK
73801-3021
US

IV. Provider business mailing address

1611 MAIN ST SUITE 103
WOODWARD OK
73801-3021
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-9275
  • Fax: 580-254-3182
Mailing address:
  • Phone: 580-254-9275
  • Fax: 580-254-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number4037
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIRECTOR BUSINESS OFFICE SUPPORT
Credential:
Phone: 615-465-7466