Provider Demographics
NPI:1063641280
Name:TOTAL RESOURCE GROUP
Entity Type:Organization
Organization Name:TOTAL RESOURCE GROUP
Other - Org Name:COVENANT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:CHRISTIE
Authorized Official - Last Name:CASTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-810-4907
Mailing Address - Street 1:5500 N WESTERN AVE
Mailing Address - Street 2:SUITE 212-A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4019
Mailing Address - Country:US
Mailing Address - Phone:405-810-4907
Mailing Address - Fax:405-810-8682
Practice Address - Street 1:5500 N WESTERN AVE
Practice Address - Street 2:SUITE 212-A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4019
Practice Address - Country:US
Practice Address - Phone:405-810-4907
Practice Address - Fax:405-810-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7500OtherOKLAHOMA STATE DEPARTMENT OF HEALTH