Provider Demographics
NPI:1376787028
Name:CHRISTIAN COMPANION SENIOR CARE OF TULSA LLC
Entity Type:Organization
Organization Name:CHRISTIAN COMPANION SENIOR CARE OF TULSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUCKABONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-394-2272
Mailing Address - Street 1:3015 E SKELLY DR
Mailing Address - Street 2:SUITE # 253
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6317
Mailing Address - Country:US
Mailing Address - Phone:918-394-2272
Mailing Address - Fax:918-392-4007
Practice Address - Street 1:3015 E SKELLY DR
Practice Address - Street 2:SUITE # 253
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6317
Practice Address - Country:US
Practice Address - Phone:918-394-2272
Practice Address - Fax:918-392-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7835253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care