Provider Demographics
NPI:1194858290
Name:SOURCE UNLIMITED INC
Entity Type:Organization
Organization Name:SOURCE UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARVETTA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:VAUGHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-840-5558
Mailing Address - Street 1:4801 N CLASSEN BLVD STE 239
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4622
Mailing Address - Country:US
Mailing Address - Phone:405-840-5558
Mailing Address - Fax:405-840-9194
Practice Address - Street 1:4801 N CLASSEN BLVD STE 239
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4622
Practice Address - Country:US
Practice Address - Phone:405-840-5558
Practice Address - Fax:405-840-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health