Provider Demographics
NPI:1477599934
Name:PRAIRIE VIEW HOME HEALTH,INC.
Entity Type:Organization
Organization Name:PRAIRIE VIEW HOME HEALTH,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-258-0035
Mailing Address - Street 1:1206 MANVEL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-4401
Mailing Address - Country:US
Mailing Address - Phone:405-258-0035
Mailing Address - Fax:405-258-0837
Practice Address - Street 1:515 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2439
Practice Address - Country:US
Practice Address - Phone:405-258-0035
Practice Address - Fax:405-258-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7815251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200096690BMedicaid
OK7815OtherSTATE LICENSE NUMBER