Provider Demographics
NPI:1295054328
Name:EPWORTH AT HOME LLC
Entity type:Organization
Organization Name:EPWORTH AT HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-767-9033
Mailing Address - Street 1:14901 N PENNYSLVANIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:405-752-1200
Mailing Address - Fax:405-755-5106
Practice Address - Street 1:14901 N PENNYSLVANIA AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134
Practice Address - Country:US
Practice Address - Phone:405-752-1200
Practice Address - Fax:405-755-5106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPWORTH LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4266251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
371685Medicare UPIN