Provider Demographics
NPI:1952470551
Name:ETON HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ETON HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR SUPERVISING NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:N
Authorized Official - Last Name:AJALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-459-9645
Mailing Address - Street 1:4706 W URBANA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5997
Mailing Address - Country:US
Mailing Address - Phone:918-459-9645
Mailing Address - Fax:918-459-9647
Practice Address - Street 1:4706 W URBANA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5997
Practice Address - Country:US
Practice Address - Phone:918-459-9645
Practice Address - Fax:918-459-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7812251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health