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General NPI Number Information
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NPI Number | 1427090851
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Entity Type | Organization
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Legal Business Name | HOLDENVILLE HOME HEALTH, LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 711 N BULLITT ST SUITE B
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City | HOLDENVILLE
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State | OK
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Zip | 74848-3804
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Country | US
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Telephone | 405-379-2300
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Fax | 405-379-2309
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Provider Business Mailing Address
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Address Line | 711 N BULLITT ST SUITE B
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City | HOLDENVILLE
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State | OK
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Zip | 74848-3804
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Country | US
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Telephone | 405-379-2300
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Fax | 405-379-2309
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARSHA L. MATHIS
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Credential |
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Telephone | 405-379-2300
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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 | 377448
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License Number State | OK
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