Provider Demographics
NPI:1942973136
Name:REDBUD HOME CARE LLC
Entity Type:Organization
Organization Name:REDBUD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-420-6153
Mailing Address - Street 1:1236 MOUNTAIN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3446
Mailing Address - Country:US
Mailing Address - Phone:405-420-6153
Mailing Address - Fax:
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD STE 103G
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4290
Practice Address - Country:US
Practice Address - Phone:405-420-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health