=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699755959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHCARE INNOVATIONS OF WESTERN OKLAHOMA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2006
-----------------------------------------------------
Last Update Date | 12/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 E MAIN ST
-----------------------------------------------------
City | WEATHERFORD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73096-5722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-774-2201
-----------------------------------------------------
Fax | 580-774-2172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6688 N CENTRAL EXPY SUITE 1300
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-239-6500
-----------------------------------------------------
Fax | 214-239-6581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP OF HOME HEALTH OPERATIONS
-----------------------------------------------------
Name | JULIE DIANE JOLLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-239-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 7741
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------