Provider Demographics
NPI:1679051122
Name:AXXESS HOME CARE, INC.
Entity Type:Organization
Organization Name:AXXESS HOME CARE, INC.
Other - Org Name:TRADITIONS HEALTH OF CHECOTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEMENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-704-6574
Mailing Address - Street 1:150 4TH AVE N STE 2300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2466
Mailing Address - Country:US
Mailing Address - Phone:979-704-6547
Mailing Address - Fax:866-908-8704
Practice Address - Street 1:206 W GENTRY AVE
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426
Practice Address - Country:US
Practice Address - Phone:918-426-0983
Practice Address - Fax:918-426-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200020750AMedicaid