Provider Demographics
NPI:1871179754
Name:CENTRAL OKLAHOMA HOMECARE LLC
Entity Type:Organization
Organization Name:CENTRAL OKLAHOMA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-938-6896
Mailing Address - Street 1:PO BOX 8175
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-8175
Mailing Address - Country:US
Mailing Address - Phone:254-265-6711
Mailing Address - Fax:
Practice Address - Street 1:2500 S BROADWAY STE 310
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4046
Practice Address - Country:US
Practice Address - Phone:405-227-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health