Provider Demographics
NPI:1962465591
Name:HEALTHBACK OF NW OKLAHOMA, INC.
Entity Type:Organization
Organization Name:HEALTHBACK OF NW OKLAHOMA, INC.
Other - Org Name:HEALTHBACK OF ENID
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-1700
Mailing Address - Street 1:16211 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8871
Mailing Address - Country:US
Mailing Address - Phone:405-842-1700
Mailing Address - Fax:405-767-1695
Practice Address - Street 1:310 S 4TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5804
Practice Address - Country:US
Practice Address - Phone:580-233-4217
Practice Address - Fax:580-233-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7574251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262830AMedicaid
OK100262830AMedicaid