1225094014 NPI number — ACCENTRA HOME HEALTHCARE INC

Table of content: (NPI 1225094014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225094014 NPI number — ACCENTRA HOME HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCENTRA HOME HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOOD SHEPHERD HOME HEALTH INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225094014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2028 E MEMORIAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73013-5515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-840-7775
Provider Business Mailing Address Fax Number:
405-840-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 S 7TH ST STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGFISHER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73750-4318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-375-6488
Provider Business Practice Location Address Fax Number:
405-283-4075
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
TRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-840-7775

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7734 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com