Provider Demographics
NPI:1457445496
Name:ROSS PRIVATE DUTY LLC
Entity Type:Organization
Organization Name:ROSS PRIVATE DUTY LLC
Other - Org Name:ROSS HEALTH CARE SERVICES PRIVATE DUTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:CHE
Authorized Official - Phone:405-224-0012
Mailing Address - Street 1:328 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2501
Mailing Address - Country:US
Mailing Address - Phone:405-224-0012
Mailing Address - Fax:405-224-2974
Practice Address - Street 1:328 S 29TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2501
Practice Address - Country:US
Practice Address - Phone:405-224-0012
Practice Address - Fax:405-224-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health