Provider Demographics
NPI:1396792909
Name:DURANT HMA HOME HEALTH, LLC
Entity type:Organization
Organization Name:DURANT HMA HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1400 BRYAN DR
Mailing Address - Street 2:STE 211
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2156
Mailing Address - Country:US
Mailing Address - Phone:580-920-8040
Mailing Address - Fax:580-920-8095
Practice Address - Street 1:1400 BRYAN DR
Practice Address - Street 2:STE 211
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2156
Practice Address - Country:US
Practice Address - Phone:580-920-8040
Practice Address - Fax:580-920-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7117251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100696610AMedicaid
OK000377078001OtherOK BC HOME HEALTH
377078Medicare Oscar/Certification