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General NPI Number Information
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NPI Number | 1104792720
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Entity Type | Organization
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Legal Business Name | PROVISION HOME CARE, LLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1051 COUNTY STREET 2983
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City | BLANCHARD
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State | OK
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Zip | 73010-4445
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Country | US
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Telephone | 405-618-7053
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Fax |
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Provider Business Mailing Address
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Address Line | 1051 COUNTY STREET 2983
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City | BLANCHARD
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State | OK
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Zip | 73010-4445
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Country | US
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Telephone | 405-618-7053
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MARLA LIN MERTS
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Credential |
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Telephone | 405-618-7053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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