Provider Demographics
NPI:1083072763
Name:EXTENDED FAMILY HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:EXTENDED FAMILY HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVINE-HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-606-4424
Mailing Address - Street 1:4200 PERIMETER CENTER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2324
Mailing Address - Country:US
Mailing Address - Phone:405-606-4424
Mailing Address - Fax:405-606-4463
Practice Address - Street 1:4200 PERIMETER CENTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2324
Practice Address - Country:US
Practice Address - Phone:405-606-4424
Practice Address - Fax:405-606-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000Medicare Oscar/Certification