Healthcare Provider Details

I. General information

NPI: 1851789069
Provider Name (Legal Business Name): SPANISH COVE HOUSING AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PALM AVE
YUKON OK
73099-5645
US

IV. Provider business mailing address

11 PALM AVE
YUKON OK
73099-5645
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-1901
  • Fax: 405-354-6584
Mailing address:
  • Phone: 405-354-1901
  • Fax: 405-354-6584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONALD N. BLOSE
Title or Position: CEO & EXECUTIVE ADMINISTRATOR
Credential:
Phone: 405-354-1901