Provider Demographics
NPI:1477599934
Name:PRAIRIE VIEW HOME HEALTH,INC.
Entity type:Organization
Organization Name:PRAIRIE VIEW HOME HEALTH,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:TARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-258-0035
Mailing Address - Street 1:1920 E 1ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-2483
Mailing Address - Country:US
Mailing Address - Phone:405-258-0035
Mailing Address - Fax:405-258-0837
Practice Address - Street 1:1920 E 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2483
Practice Address - Country:US
Practice Address - Phone:405-258-0035
Practice Address - Fax:405-258-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7815251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7815OtherSTATE LICENSE NUMBER
OK200096690BMedicaid