Provider Demographics
NPI:1245233170
Name:COMPANION HOME HEALTH, LLC
Entity Type:Organization
Organization Name:COMPANION HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHCA
Authorized Official - Phone:405-293-9000
Mailing Address - Street 1:1310 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3757
Mailing Address - Country:US
Mailing Address - Phone:405-293-9000
Mailing Address - Fax:405-293-9001
Practice Address - Street 1:1310 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3757
Practice Address - Country:US
Practice Address - Phone:405-282-3402
Practice Address - Fax:405-282-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7790251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000377683001OtherBLUE CROSS BLUE SHIELD
OK200049690 AMedicaid
OK200049690 AMedicaid