Provider Demographics
NPI:1376655670
Name:SPECIALIZED HOME NURSING, INC.
Entity Type:Organization
Organization Name:SPECIALIZED HOME NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-481-8111
Mailing Address - Street 1:7125 S BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6302
Mailing Address - Country:US
Mailing Address - Phone:918-481-8111
Mailing Address - Fax:918-481-8110
Practice Address - Street 1:7125 S BRADEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6302
Practice Address - Country:US
Practice Address - Phone:918-481-8111
Practice Address - Fax:918-481-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7316251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100809910AMedicaid
OK100809910EMedicaid
OK100809910DMedicaid
OK100809910BMedicaid
OK100809910CMedicaid
OK100809910BMedicaid