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General NPI Number Information
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NPI Number | 1245568070
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Entity Type | Organization
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Legal Business Name | PETERS AGENCY HOME CARE, LLC
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 1015 EAST CHOCTAW AVENUE
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City | SALLISAW
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State | OK
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Zip | 74955-5011
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Country | US
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Telephone | 918-790-7555
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Fax | 918-790-7587
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Provider Business Mailing Address
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Address Line | 1015 EAST CHOCTAW AVENUE
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City | SALLISAW
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State | OK
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Zip | 74955-5011
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Country | US
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Telephone | 918-790-7555
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Fax | 918-790-7587
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Authorized Official
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Title or Position | CEO
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Name | MRS. TRUDY A PETERS
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Credential | MBA, RN, CCM, LHCA
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Telephone | 918-775-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 7891
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 7891
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 7891
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 7891
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License Number State | OK
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