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General NPI Number Information
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NPI Number | 1245430073
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Entity Type | Organization
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Legal Business Name | DYNAMICARE
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1409 E RENO ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-9380
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Country | US
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Telephone | 918-720-3442
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Fax | 918-355-1330
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Provider Business Mailing Address
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Address Line | 1409 E RENO ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-9380
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Country | US
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Telephone | 918-720-3442
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Fax | 918-355-1330
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL MCCARTHY
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Credential | LPTA
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Telephone | 918-720-3442
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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 | TA748
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License Number State | OK
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