MEDICARE: HEALTHCARE INNOVATIONS IN-HOME SERVICES OF PURCELL 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	377502	OTHER	OK	MEDICARE P-TAN NUMBER

General Provider Information

NPI Number	:	1952667651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE INNOVATIONS IN-HOME SERVICES OF PURCELL LLC

Provider Business Mailing Address
First Line	:	210 N MAIN
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-4222
Country	:	US
Telephone Number	:	405-527-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N MAIN
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-4222
Country	:	US
Telephone Number	:	405-527-0480
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT /ADMINISTRATOR
Name	:	MS. LOLA JANE EDWARDS
Credential	:	RN
Telephone Number	:	918-360-7014

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	05/20/2020

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