Provider Demographics
NPI:1770638157
Name:CLEVELAND AREA HOSPITAL HOME HEALTH
Entity Type:Organization
Organization Name:CLEVELAND AREA HOSPITAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-358-2483
Mailing Address - Street 1:901 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-1205
Mailing Address - Country:US
Mailing Address - Phone:918-358-2483
Mailing Address - Fax:918-358-2641
Practice Address - Street 1:901 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-1205
Practice Address - Country:US
Practice Address - Phone:918-358-2483
Practice Address - Fax:918-358-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7167251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377138Medicare ID - Type UnspecifiedPROVIDER