=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073974879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CHOICE HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2016
-----------------------------------------------------
Last Update Date | 06/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 ACCESS RD
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-4140
-----------------------------------------------------
Fax | 580-670-2522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 W 2ND ST
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644-4608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-4140
-----------------------------------------------------
Fax | 580-670-2522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. FINNY JOSEPH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-225-4140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7852
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------