Provider Demographics
NPI:1881138626
Name:INTERIM HEALTHCARE OF OKLAHOMA CITY, INC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF OKLAHOMA CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-848-3555
Mailing Address - Street 1:3613 NW 56TH ST
Mailing Address - Street 2:SUITE 385
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4526
Mailing Address - Country:US
Mailing Address - Phone:405-848-3555
Mailing Address - Fax:408-842-4629
Practice Address - Street 1:3613 NW 56TH ST
Practice Address - Street 2:SUITE 385
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4526
Practice Address - Country:US
Practice Address - Phone:405-848-3555
Practice Address - Fax:408-842-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK377658251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262720AMedicaid
OK100262720AMedicaid