1275558280 NPI number — LIFESPRING HOME CARE OF SAYRE, LLC

Table of content: (NPI 1275558280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275558280 NPI number — LIFESPRING HOME CARE OF SAYRE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFESPRING HOME CARE OF SAYRE, LLC
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:
Provider Other Organization Name Type Code:
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:
1275558280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2411 SPRINGER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-329-4545
Provider Business Mailing Address Fax Number:
405-310-3371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAYRE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73662-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-928-2275
Provider Business Practice Location Address Fax Number:
580-928-4475
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAHLBERG
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-329-4545

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7321 , 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)

  • Identifier: 100700160D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".