Provider Demographics
NPI:1750490835
Name:CARTER HEALTHCARE OF SOUTHWEST OKLAHOMA, LLC
Entity Type:Organization
Organization Name:CARTER HEALTHCARE OF SOUTHWEST OKLAHOMA, LLC
Other - Org Name:CARTER HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-7700
Mailing Address - Street 1:3105 S MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-1022
Mailing Address - Country:US
Mailing Address - Phone:405-947-7700
Mailing Address - Fax:405-947-7300
Practice Address - Street 1:5366 NW CACHE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3335
Practice Address - Country:US
Practice Address - Phone:580-353-0377
Practice Address - Fax:580-353-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7687251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100261610DMedicaid
OK100261610DMedicaid