Provider Demographics
NPI:1861494759
Name:COUNTRY STYLE HEALTH CARE INC VII
Entity Type:Organization
Organization Name:COUNTRY STYLE HEALTH CARE INC VII
Other - Org Name:OKLAHOMA HEALTHCARE SOLUTIONS VII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-2626
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:69711 HWY 259
Mailing Address - City:SMITHVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74957-0097
Mailing Address - Country:US
Mailing Address - Phone:580-244-3488
Mailing Address - Fax:580-244-3540
Practice Address - Street 1:69711 HWY 259
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:OK
Practice Address - Zip Code:74957
Practice Address - Country:US
Practice Address - Phone:580-244-3488
Practice Address - Fax:580-244-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7672251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262710AMedicaid
OK377627Medicare Oscar/Certification