Provider Demographics
NPI:1841919594
Name:TILDAN HOME HEALTHCARE AGENCY LLC
Entity type:Organization
Organization Name:TILDAN HOME HEALTHCARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TILDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-304-4061
Mailing Address - Street 1:PO BOX 1862
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-1862
Mailing Address - Country:US
Mailing Address - Phone:918-260-6299
Mailing Address - Fax:
Practice Address - Street 1:11090 N 160 RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-9180
Practice Address - Country:US
Practice Address - Phone:918-260-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1841919594Medicaid
OK883874303OtherHEALTH PROVIDER