Provider Demographics
NPI:1649437351
Name:HEALING WATERS HOME HEALTH LLC
Entity type:Organization
Organization Name:HEALING WATERS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-427-2702
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-0129
Mailing Address - Country:US
Mailing Address - Phone:918-427-2702
Mailing Address - Fax:918-427-2702
Practice Address - Street 1:205 E RAY FINE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5181
Practice Address - Country:US
Practice Address - Phone:918-427-2702
Practice Address - Fax:918-427-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health