Provider Demographics
NPI:1669473104
Name:COUNTRY STYLE HEALTH CARE INC X
Entity Type:Organization
Organization Name:COUNTRY STYLE HEALTH CARE INC X
Other - Org Name:OKLAHOMA HEALTHCARE SOLUTIONS X
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:918-689-5352
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-0396
Mailing Address - Country:US
Mailing Address - Phone:405-283-3303
Mailing Address - Fax:405-373-1792
Practice Address - Street 1:414 PIEDMONT RD N STE A
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9545
Practice Address - Country:US
Practice Address - Phone:405-283-3303
Practice Address - Fax:405-373-1792
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
OKHC7690251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1002627408AMedicaid
OK377631Medicare Oscar/Certification