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NPI Code Detail

MEDICARE: COUNTRY STYLE HEALTH CARE INC VII

MEDICARE: COUNTRY STYLE HEALTH CARE INC VII
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
1251E00000XHome Health AgencyHC7672OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861494759
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRY STYLE HEALTH CARE INC VII
Provider Business Mailing Address
First Line : 2301 HIGHWAY 1187 STE 203
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-6139
Country : US
Telephone Number : 817-539-2427
Fax Number : 817-549-4150
Provider Business Practice Location Address
First Line : 824 S BROADWAY ST
Second Line :
City : POTEAU
State : OK
Zip : 74953-3834
Country : US
Telephone Number : 918-647-5100
Fax Number : 918-649-0532
Authorized Official
Title or Position : PRESIDENT
Name : ANGELA EDDINS
Credential :
Telephone Number : 817-539-2427
Provider Enumeration Date : 08/11/2005
Last Update Date : 01/06/2025

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Practice Location Address:
804 S BROADWAY ST
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1073718375 — CHERI STAHLMAN MS, LPC
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1275769937 — CASSANDRA LEE CUMMINS MBS LPC
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Practice Fax: 918-649-0136
1063748689 — ROXANNE ELIZABETH WATSON MS, LPC
Practice Location Address:
804 S BROADWAY ST
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1508171752 — MRS. STEPHANIE MARIE DIAMOND M.ED., LPC
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804 S BROADWAY ST
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1255602553 — MRS. DANA RENE THOMPSON LPC
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Directions to “COUNTRY STYLE HEALTH CARE INC VII ” Practice Location

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