Provider Demographics
NPI:1114004926
Name:AHS HENRYETTA HOSPITAL LLC
Entity Type:Organization
Organization Name:AHS HENRYETTA HOSPITAL LLC
Other - Org Name:HILLCREST REGIONAL HOME HEALTH SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-650-1300
Mailing Address - Street 1:1924 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENRYETTA
Mailing Address - State:OK
Mailing Address - Zip Code:74437-3849
Mailing Address - Country:US
Mailing Address - Phone:918-652-4463
Mailing Address - Fax:918-652-3675
Practice Address - Street 1:1924 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-3849
Practice Address - Country:US
Practice Address - Phone:918-652-4463
Practice Address - Fax:918-652-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377068Medicare ID - Type UnspecifiedMEDICARE HH