Provider Demographics
NPI:1104036748
Name:COMPREHENSIVE PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-592-4953
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74872-0636
Mailing Address - Country:US
Mailing Address - Phone:580-759-2313
Mailing Address - Fax:580-759-3567
Practice Address - Street 1:131 COTTONWOOD STREET
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:OK
Practice Address - Zip Code:74872-0636
Practice Address - Country:US
Practice Address - Phone:580-759-2313
Practice Address - Fax:580-759-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOKNH2505313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility