Provider Demographics
NPI:1487655924
Name:COUNTRY STYLE HEALTH CARE INC VIII
Entity Type:Organization
Organization Name:COUNTRY STYLE HEALTH CARE INC VIII
Other - Org Name:OKLAHOMA HEALTHCARE SOLUTIONS VIII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-2626
Mailing Address - Street 1:315 E WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5405
Mailing Address - Country:US
Mailing Address - Phone:918-421-8822
Mailing Address - Fax:918-421-8826
Practice Address - Street 1:315 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5405
Practice Address - Country:US
Practice Address - Phone:918-421-8822
Practice Address - Fax:918-421-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HC7673251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100686300BMedicaid
OK377629Medicare Oscar/Certification