Provider Demographics
NPI:1336289412
Name:HOME HEALTH AGENCY-OKLAHOMA CITY, LLC
Entity Type:Organization
Organization Name:HOME HEALTH AGENCY-OKLAHOMA CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-382-8500
Mailing Address - Street 1:8205 E REGAL CT STE 108
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7183
Mailing Address - Country:US
Mailing Address - Phone:918-828-7700
Mailing Address - Fax:918-512-4396
Practice Address - Street 1:9810 E 42ND ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3653
Practice Address - Country:US
Practice Address - Phone:918-828-7700
Practice Address - Fax:918-828-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7085251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377273Medicare PIN
OK377273Medicare Oscar/Certification