Provider Demographics
NPI:1558716084
Name:OK4 HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:OK4 HOME HEALTH AGENCY LLC
Other - Org Name:OUTREACH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-724-8950
Mailing Address - Street 1:2303 S YORK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-8876
Mailing Address - Country:US
Mailing Address - Phone:918-682-6400
Mailing Address - Fax:
Practice Address - Street 1:2303 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-8876
Practice Address - Country:US
Practice Address - Phone:918-682-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377712Medicare Oscar/Certification