Provider Demographics
NPI:1609174416
Name:ALL ABOUT FAMILY-PRIVATE DUTY SERVICE, INC.
Entity Type:Organization
Organization Name:ALL ABOUT FAMILY-PRIVATE DUTY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:918-302-0070
Mailing Address - Street 1:106 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5300
Mailing Address - Country:US
Mailing Address - Phone:918-302-0070
Mailing Address - Fax:918-302-0073
Practice Address - Street 1:106 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5300
Practice Address - Country:US
Practice Address - Phone:918-302-0070
Practice Address - Fax:918-302-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7953251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health