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General NPI Number Information
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NPI Number | 1811232127
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Entity Type | Organization
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Legal Business Name | TICKLED PINK FOOT CARE LLC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 1491 ASH HOLW
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City | CATOOSA
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State | OK
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Zip | 74015-2201
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Country | US
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Telephone | 918-407-8742
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Fax | 918-739-5074
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Provider Business Mailing Address
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Address Line | PO BOX 535
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City | CATOOSA
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State | OK
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Zip | 74015-0535
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Country | US
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Telephone | 918-407-8742
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Fax | 918-739-5074
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Authorized Official
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Title or Position | OWNER
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Name | TYLER BENJAMIN GOINS
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Credential |
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Telephone | 918-407-8742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | L0051752
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License Number State | OK
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