Provider Demographics
NPI:1326348434
Name:EPWORTH AT HOME LLC
Entity Type:Organization
Organization Name:EPWORTH AT HOME LLC
Other - Org Name:CENTRAL OKLAHOMA UNITED METHODIST RETIREMENT FACILITY INC DBA EPWORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:405-752-1200
Mailing Address - Street 1:14901 N. PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-752-1200
Mailing Address - Fax:405-755-5106
Practice Address - Street 1:14901 N. PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-752-1200
Practice Address - Fax:405-755-5106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPWORTH LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-25
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
37763Medicare UPIN