Provider Demographics
NPI:1720269962
Name:ROSS PRIVATE DUTY LLC
Entity Type:Organization
Organization Name:ROSS PRIVATE DUTY LLC
Other - Org Name:ROSS HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-0012
Mailing Address - Street 1:328 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2501
Mailing Address - Country:US
Mailing Address - Phone:405-224-0012
Mailing Address - Fax:
Practice Address - Street 1:2221 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2739
Practice Address - Country:US
Practice Address - Phone:405-222-7085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7124332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies