Provider Demographics
NPI:1770285561
Name:HCA84 LLC
Entity type:Organization
Organization Name:HCA84 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:WILLARD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-641-7565
Mailing Address - Street 1:13829 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5010
Mailing Address - Country:US
Mailing Address - Phone:405-286-0388
Mailing Address - Fax:405-694-4509
Practice Address - Street 1:13829 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-5010
Practice Address - Country:US
Practice Address - Phone:405-286-0388
Practice Address - Fax:405-694-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care