Provider Demographics
NPI:1437104924
Name:AT HOME IN OKLAHOMA, INC
Entity Type:Organization
Organization Name:AT HOME IN OKLAHOMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:ROUNTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-708-9408
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465
Mailing Address - Country:US
Mailing Address - Phone:918-708-9408
Mailing Address - Fax:918-458-0785
Practice Address - Street 1:1409 S MUSKOGEE AVE STE 2
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-708-9408
Practice Address - Fax:918-458-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7730251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377657Medicare ID - Type UnspecifiedHOME HEALTH AGENCY