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General NPI Number Information
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NPI Number | 1518969740
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HOME CARE OF GARVIN COUNTY OKLAHOMA INC
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 2510 W GRANT AVE
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City | PAULS VALLEY
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State | OK
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Zip | 73075-9247
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Country | US
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Telephone | 405-238-7563
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Fax | 405-238-5990
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Provider Business Mailing Address
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Address Line | 2510 W GRANT AVE
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City | PAULS VALLEY
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State | OK
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Zip | 73075-9247
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Country | US
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Telephone | 405-238-7563
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Fax | 405-238-5990
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. TONY HOVIS
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Credential |
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Telephone | 405-238-7563
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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 | 7328
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License Number State | OK
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