Provider Demographics
NPI:1114478450
Name:GRAYSON HOME HEALTH
Entity Type:Organization
Organization Name:GRAYSON HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:STUDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-745-9470
Mailing Address - Street 1:112 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4738
Mailing Address - Country:US
Mailing Address - Phone:580-745-9470
Mailing Address - Fax:580-745-9470
Practice Address - Street 1:112 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4738
Practice Address - Country:US
Practice Address - Phone:580-745-9470
Practice Address - Fax:580-745-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK377729251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1801062518Medicare PIN