Provider Demographics
NPI:1619915493
Name:DEACONESS HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:DEACONESS HEALTH SYSTEM LLC
Other - Org Name:DEACONESS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, BUSINESS OFFICE SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:7600 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4944
Mailing Address - Country:US
Mailing Address - Phone:405-604-6000
Mailing Address - Fax:405-604-6153
Practice Address - Street 1:7600 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4944
Practice Address - Country:US
Practice Address - Phone:405-604-6000
Practice Address - Fax:405-604-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2294251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
377420Medicare Oscar/Certification