Provider Demographics
NPI:1811232127
Name:TICKLED PINK FOOT CARE LLC
Entity Type:Organization
Organization Name:TICKLED PINK FOOT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-407-8742
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-0535
Mailing Address - Country:US
Mailing Address - Phone:918-407-8742
Mailing Address - Fax:918-739-5074
Practice Address - Street 1:1491 ASH HOLW
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2201
Practice Address - Country:US
Practice Address - Phone:918-407-8742
Practice Address - Fax:918-739-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0051752251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care