=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053254755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATERELLI HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2026
-----------------------------------------------------
Last Update Date | 04/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 S BROADWAY ST STE B
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74020-4614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-856-3900
-----------------------------------------------------
Fax | 918-901-9994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 S BROADWAY ST STE B
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74020-4614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-856-3900
-----------------------------------------------------
Fax | 918-901-9994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | RAYMOND LEACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-856-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------