Provider Demographics
NPI:1467641696
Name:SHANADOA HOME HEALTH, INC.
Entity Type:Organization
Organization Name:SHANADOA HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-331-0800
Mailing Address - Street 1:2448 E 81ST ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4307
Mailing Address - Country:US
Mailing Address - Phone:918-331-0800
Mailing Address - Fax:918-331-0805
Practice Address - Street 1:2448 E 81ST ST STE 1400
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4307
Practice Address - Country:US
Practice Address - Phone:918-331-0800
Practice Address - Fax:918-331-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200402060CMedicaid