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General NPI Number Information
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NPI Number | 1831182625
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Entity Type | Organization
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Legal Business Name | COUNTRY STYLE HEALTH CARE INC IV
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 301 S MAIN ST
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City | EUFAULA
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State | OK
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Zip | 74432-3253
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Country | US
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Telephone | 918-689-5352
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Fax | 918-689-9446
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Provider Business Mailing Address
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Address Line | 301 S MAIN ST
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City | EUFAULA
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State | OK
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Zip | 74432-3253
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Country | US
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Telephone | 918-689-5352
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Fax | 918-689-9446
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | JACKIE C BROWNE
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Credential |
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Telephone | 918-689-5352
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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 | HC7647
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License Number State | OK
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