Provider Demographics
NPI:1457480592
Name:ALTRIA HEALTH CARE INC
Entity Type:Organization
Organization Name:ALTRIA HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAINA
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-601-8337
Mailing Address - Street 1:2512 SW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-5740
Mailing Address - Country:US
Mailing Address - Phone:405-601-8337
Mailing Address - Fax:405-601-8337
Practice Address - Street 1:2512 SW 86TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-5740
Practice Address - Country:US
Practice Address - Phone:405-601-8337
Practice Address - Fax:405-601-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management