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General NPI Number Information
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NPI Number | 1154727014
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Entity Type | Organization
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Legal Business Name | JEROME HOLMES
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 3855 RIVERSIDE DR
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City | TULSA
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State | OK
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Zip | 74105-3045
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Country | US
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Telephone | 918-743-4768
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Fax |
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Provider Business Mailing Address
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Address Line | 3855 RIVERSIDE DR
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City | TULSA
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State | OK
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Zip | 74105-3045
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Country | US
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Telephone | 918-743-4768
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | MR. JEROME HOLMES III
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Credential |
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Telephone | 918-743-4768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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