Provider Demographics
NPI:1740247113
Name:PROFESSIONAL HOME HEALTH CARE INC
Entity type:Organization
Organization Name:PROFESSIONAL HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELISAQ
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-270-4950
Mailing Address - Street 1:10301 E 51 ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5808
Mailing Address - Country:US
Mailing Address - Phone:918-270-4950
Mailing Address - Fax:918-270-4952
Practice Address - Street 1:109 N BLAKE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467
Practice Address - Country:US
Practice Address - Phone:918-485-8565
Practice Address - Fax:918-485-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100808980AMedicaid
OK100808980AMedicaid