MEDICARE: INNOVATIVE SENIOR CARE HOME HEALTH OF EDMOND 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	251F00000X	Home Infusion Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1447561741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE SENIOR CARE HOME HEALTH OF EDMOND LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-443-4154

Provider Business Practice Location Address
First Line	:	5600 N MAY AVE
Second Line	:	STE 147
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3973
Country	:	US
Telephone Number	:	405-341-4361
Fax Number	:	405-341-4349

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSHUA L. PROFFITT
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	07/25/2024

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