Provider Demographics
NPI:1770675449
Name:LATIMER COUNTY HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:LATIMER COUNTY HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LAJUAN
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-465-4241
Mailing Address - Street 1:806 HWY 2 NORTH
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3625
Mailing Address - Country:US
Mailing Address - Phone:918-465-4241
Mailing Address - Fax:918-465-5795
Practice Address - Street 1:202 EAST MAIN
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4232
Practice Address - Country:US
Practice Address - Phone:918-465-4241
Practice Address - Fax:918-465-5795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATIMER COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7018251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377282Medicare Oscar/Certification