MEDICARE: MATERELLI HOME HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053254755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATERELLI HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	113 S BROADWAY ST STE B
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4614
Country	:	US
Telephone Number	:	918-856-3900
Fax Number	:	918-901-9994

Provider Business Practice Location Address
First Line	:	113 S BROADWAY ST STE B
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4614
Country	:	US
Telephone Number	:	918-856-3900
Fax Number	:	918-901-9994

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	RAYMOND LEACH
Credential	:
Telephone Number	:	918-856-3900

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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