MEDICARE: NORTHWEST HOME CARE 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	7729	OK

General Provider Information

NPI Number	:	1104107705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HOME CARE LLC

Provider Business Mailing Address
First Line	:	5400 NW 23RD ST
Second Line	:	STE 206
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-2367
Country	:	US
Telephone Number	:	405-604-0373
Fax Number	:	405-604-0383

Provider Business Practice Location Address
First Line	:	5400 NW 23RD ST
Second Line	:	STE 206
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-2367
Country	:	US
Telephone Number	:	405-604-0373
Fax Number	:	405-604-0383

Authorized Official
Title or Position	:	CEO
Name	:	MR. KEHDINGA NUKUNA
Credential	:
Telephone Number	:	405-604-0373

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	03/30/2012

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