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General NPI Number Information
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NPI Number | 1982905436
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Entity Type | Organization
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Legal Business Name | PROVIDENCE EXCEL HOME CARE
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 4845 S SHERIDAN RD STE 502
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City | TULSA
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State | OK
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Zip | 74145-5719
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Country | US
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Telephone | 918-794-4334
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Fax | 918-794-4344
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Provider Business Mailing Address
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Address Line | 4845 S SHERIDAN RD STE 502
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City | TULSA
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State | OK
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Zip | 74145-5719
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Country | US
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Telephone | 918-794-4334
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Fax | 918-794-4344
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. AMOS O. ADESOKAN
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Credential | RN BSN
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Telephone | 918-625-4797
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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 | CSS0016
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License Number State | OK
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