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General NPI Number Information
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NPI Number | 1487904728
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Entity Type | Organization
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Legal Business Name | GOLDEN HEART SENIOR CARE OF OKLAHOMA
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 7301 BROADWAY EXT STE 118 SUITE 118
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-9045
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Country | US
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Telephone | 405-796-4848
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Fax | 405-607-4881
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Provider Business Mailing Address
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Address Line | 7301 BROADWAY EXT STE 118 SUITE 118
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-9045
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Country | US
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Telephone | 405-796-4848
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Fax | 405-607-4881
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MR. DEREK J MILLER
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Credential |
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Telephone | 405-796-4848
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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 | 7999
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License Number State | OK
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