Provider Demographics
NPI:1275189300
Name:A PATH OF CARE HOME HEALTH V, LLC
Entity Type:Organization
Organization Name:A PATH OF CARE HOME HEALTH V, LLC
Other - Org Name:A PATH OF CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:2910 ADAMS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1023
Mailing Address - Country:US
Mailing Address - Phone:405-927-2727
Mailing Address - Fax:405-927-2720
Practice Address - Street 1:601 HIGHWAY 70 N
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-8206
Practice Address - Country:US
Practice Address - Phone:580-564-0000
Practice Address - Fax:580-564-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200966320AMedicaid