Provider Demographics
NPI:1396819660
Name:HCIPS IN-HOME SERVICES OF HUGO, LLC
Entity type:Organization
Organization Name:HCIPS IN-HOME SERVICES OF HUGO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-360-7014
Mailing Address - Street 1:303 W JACKSON
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3342
Mailing Address - Country:US
Mailing Address - Phone:580-326-6877
Mailing Address - Fax:580-326-7775
Practice Address - Street 1:303 W JACKSON
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3342
Practice Address - Country:US
Practice Address - Phone:580-326-6877
Practice Address - Fax:580-326-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7086163WH0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
377193Medicare PIN
OK377193Medicare Oscar/Certification