Provider Demographics
NPI:1275558280
Name:LIFESPRING HOME CARE OF SAYRE, LLC
Entity Type:Organization
Organization Name:LIFESPRING HOME CARE OF SAYRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAHLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-329-4545
Mailing Address - Street 1:2411 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3955
Mailing Address - Country:US
Mailing Address - Phone:405-329-4545
Mailing Address - Fax:405-310-3371
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-2916
Practice Address - Country:US
Practice Address - Phone:580-928-2275
Practice Address - Fax:580-928-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7321251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700160DMedicaid
OK377219Medicare Oscar/Certification