Provider Demographics
NPI:1093826695
Name:PHC HEALTH, LLC
Entity Type:Organization
Organization Name:PHC HEALTH, LLC
Other - Org Name:PROVIDENCE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:405-602-3295
Mailing Address - Street 1:2831 NW 59TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7005
Mailing Address - Country:US
Mailing Address - Phone:405-602-3295
Mailing Address - Fax:405-602-3297
Practice Address - Street 1:2831 NW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7005
Practice Address - Country:US
Practice Address - Phone:405-602-3295
Practice Address - Fax:405-602-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7724251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262820AMedicaid
OK000377645-001OtherBLUE CROSS & BLUE SHIED
OK100262820AMedicaid