Provider Demographics
NPI:1245511880
Name:COMPLETECARE HOME HEALTH PLUS LLC
Entity type:Organization
Organization Name:COMPLETECARE HOME HEALTH PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:2401 TEE CIR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6207
Mailing Address - Country:US
Mailing Address - Phone:405-928-2727
Mailing Address - Fax:405-928-2720
Practice Address - Street 1:15951 LITTLE AXE DR
Practice Address - Street 2:SUITE 1816
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-9088
Practice Address - Country:US
Practice Address - Phone:405-701-7085
Practice Address - Fax:405-701-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7127251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100726080DMedicaid
OK100726080DMedicaid