Provider Demographics
NPI:1831160134
Name:PROFESSIONAL PROVIDER CARE, INC.
Entity type:Organization
Organization Name:PROFESSIONAL PROVIDER CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GIRDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-776-9400
Mailing Address - Street 1:103 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4438
Mailing Address - Country:US
Mailing Address - Phone:918-776-9400
Mailing Address - Fax:918-776-9200
Practice Address - Street 1:103 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4438
Practice Address - Country:US
Practice Address - Phone:918-776-9400
Practice Address - Fax:918-776-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care