=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497852545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CHOICE HOME CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1925 W 3RD ST
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-4140
-----------------------------------------------------
Fax | 580-225-4102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1925 W 3RD ST
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-225-4140
-----------------------------------------------------
Fax | 580-225-4102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | MRS. MISTY DAWN WARNKE
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 580-225-4140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7852
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------