Provider Demographics
NPI:1346405396
Name:PETERS AGENCY HOME CARE LLC
Entity Type:Organization
Organization Name:PETERS AGENCY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCM
Authorized Official - Phone:918-775-6555
Mailing Address - Street 1:1900 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2617
Mailing Address - Country:US
Mailing Address - Phone:405-601-9605
Mailing Address - Fax:405-601-9606
Practice Address - Street 1:1900 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2617
Practice Address - Country:US
Practice Address - Phone:405-601-9605
Practice Address - Fax:405-601-9606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETERS AGENCY HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7891251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100685560AMedicaid