Provider Demographics
NPI:1720338932
Name:INTERIM HEALTHCARE OF OKLAHOMA CITY, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF OKLAHOMA CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-848-3555
Mailing Address - Street 1:5600 N MAY AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3973
Mailing Address - Country:US
Mailing Address - Phone:405-848-3555
Mailing Address - Fax:405-842-4629
Practice Address - Street 1:5600 N MAY AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3973
Practice Address - Country:US
Practice Address - Phone:405-848-3555
Practice Address - Fax:405-842-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7037251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262720AMedicaid
OK377658Medicare Oscar/Certification