=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831334911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENCHMARK HOME HEALTH, PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2008
-----------------------------------------------------
Last Update Date | 03/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 136 N GREENWOOD AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74120-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-592-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 616 S BOSTON AVE SUITE 402
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74119-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MECHELLE PETTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-592-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC7896
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------