Provider Demographics
NPI:1679750889
Name:OSAGE HOME HEALTH
Entity Type:Organization
Organization Name:OSAGE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-2991
Mailing Address - Street 1:1449 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-5907
Mailing Address - Country:US
Mailing Address - Phone:918-287-5645
Mailing Address - Fax:918-287-5572
Practice Address - Street 1:1449 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-5907
Practice Address - Country:US
Practice Address - Phone:918-287-5645
Practice Address - Fax:918-287-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7339251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377509Medicare Oscar/Certification