Provider Demographics
NPI:1831191543
Name:OMH HOME HEALTH
Entity type:Organization
Organization Name:OMH HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/IT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-4233
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-1038
Mailing Address - Country:US
Mailing Address - Phone:918-756-4233
Mailing Address - Fax:918-756-5968
Practice Address - Street 1:1401 MORRIS DRIVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6429
Practice Address - Country:US
Practice Address - Phone:918-756-4233
Practice Address - Fax:918-756-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7077251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000377094-001OtherBLUE CROSS
OK106260940AMedicaid
OK100700360EMedicaid
OK000377094001OtherBLUE CROSS
OK100700360EMedicaid
OK377094Medicare PIN