Provider Demographics
NPI:1366015216
Name:HAYES, TIMOTHY (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 E 53RD ST # 132
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4050
Mailing Address - Country:US
Mailing Address - Phone:918-430-3088
Mailing Address - Fax:
Practice Address - Street 1:4515 E 53RD ST # 132
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4050
Practice Address - Country:US
Practice Address - Phone:918-430-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCSS0800163WH0200X, 374U00000X, 385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty