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General NPI Number Information
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NPI Number | 1669473104
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Entity Type | Organization
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Legal Business Name | COUNTRY STYLE HEALTH CARE INC X
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1317 N 16TH AVE
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City | DURANT
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State | OK
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Zip | 74701-2134
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Country | US
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Telephone | 580-931-3055
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 HIGHWAY 1187 STE 203
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City | MANSFIELD
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State | TX
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Zip | 76063-6139
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Country | US
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Telephone | 817-539-2427
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Fax | 817-549-4150
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA W EDDINS
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Credential |
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Telephone | 817-539-2427
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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 | HC7690
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License Number State | OK
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