Provider Demographics
NPI:1558616342
Name:HEALTHCARE INNOVATIONS OF WESTERN OKLAHOMA, LLC
Entity Type:Organization
Organization Name:HEALTHCARE INNOVATIONS OF WESTERN OKLAHOMA, LLC
Other - Org Name:ENHABIT HOME HEALTH OF WESTERN OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISSY
Authorized Official - Middle Name:BUCHANAN
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-239-6500
Mailing Address - Street 1:6688 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3950
Mailing Address - Country:US
Mailing Address - Phone:214-239-6500
Mailing Address - Fax:214-239-6581
Practice Address - Street 1:6202 NW OAK AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4323
Practice Address - Country:US
Practice Address - Phone:580-248-7400
Practice Address - Fax:580-248-7401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENHABIT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7893251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200260890AMedicaid
OK37D1086417OtherCLIA
OK37D1086417OtherCLIA