Provider Demographics
NPI:1467430595
Name:IDEAL HOME CARE, LLC
Entity type:Organization
Organization Name:IDEAL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:580-226-2323
Mailing Address - Street 1:2417 CHICKASAW BLVD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1466
Mailing Address - Country:US
Mailing Address - Phone:580-226-2323
Mailing Address - Fax:580-226-2326
Practice Address - Street 1:2417 CHICKASAW BLVD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1466
Practice Address - Country:US
Practice Address - Phone:580-226-2323
Practice Address - Fax:580-226-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7781251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377678Medicare ID - Type UnspecifiedHOME HEALTH