Provider Demographics
NPI:1093739120
Name:INTEGRIS BLACKWELL HOME HEALTH & HOSPICE
Entity Type:Organization
Organization Name:INTEGRIS BLACKWELL HOME HEALTH & HOSPICE
Other - Org Name:INTEGRIS BLACKWELL REGIONAL HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:706 S 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-3700
Mailing Address - Country:US
Mailing Address - Phone:580-363-2311
Mailing Address - Fax:580-363-9352
Practice Address - Street 1:710 S 13TH ST
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-3700
Practice Address - Country:US
Practice Address - Phone:580-363-2311
Practice Address - Fax:580-363-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7335251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700340BMedicaid
OK100700340BMedicaid