MEDICARE: ROSS PRIVATE DUTY 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	7124	OK

General Provider Information

NPI Number	:	1457445496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS PRIVATE DUTY LLC

Provider Business Mailing Address
First Line	:	328 S 29TH ST
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-2501
Country	:	US
Telephone Number	:	405-224-0012
Fax Number	:	405-224-2974

Provider Business Practice Location Address
First Line	:	328 S 29TH ST
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-2501
Country	:	US
Telephone Number	:	405-224-0012
Fax Number	:	405-224-2974

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. HENRY P ROSS
Credential	:	CHE
Telephone Number	:	405-224-0012

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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Directions to “ROSS PRIVATE DUTY LLC ” Practice Location

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