Provider Demographics
NPI:1891116232
Name:COMPLETE HOME HEALTH OF TISHOMINGO LLC
Entity Type:Organization
Organization Name:COMPLETE HOME HEALTH OF TISHOMINGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MS
Authorized Official - Phone:803-719-3005
Mailing Address - Street 1:315 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-4824
Mailing Address - Country:US
Mailing Address - Phone:580-371-9300
Mailing Address - Fax:
Practice Address - Street 1:315 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-4824
Practice Address - Country:US
Practice Address - Phone:580-371-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7830251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7830OtherLICENSE
OK7830OtherLICENSE