Provider Demographics
NPI:1851775068
Name:HEALTH WATCH HOSPICE OF GUYMON, LLC
Entity Type:Organization
Organization Name:HEALTH WATCH HOSPICE OF GUYMON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-905-4810
Mailing Address - Street 1:3310A LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460
Mailing Address - Country:US
Mailing Address - Phone:903-905-4810
Mailing Address - Fax:
Practice Address - Street 1:1203 N ELLISON ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-3657
Practice Address - Country:US
Practice Address - Phone:580-338-2274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4051251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based