1730454000 NPI number — ADVOCATE HOME HEALTH CARE INC

Table of content: JESSICA ROSE LINCOLN MS, RDN, LD, CNSC (NPI 1407528979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730454000 NPI number — ADVOCATE HOME HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVOCATE HOME HEALTH CARE 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:
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:
1730454000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 N CLASSEN BLVD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73118-4822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-242-2788
Provider Business Mailing Address Fax Number:
405-242-2798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 N CLASSEN BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118-4822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-242-2788
Provider Business Practice Location Address Fax Number:
405-242-2798
Provider Enumeration Date:
03/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TITAJANI
Authorized Official First Name:
DIVINE
Authorized Official Middle Name:
BABILA
Authorized Official Title or Position:
FACILITY ADMINISTRATOR
Authorized Official Telephone Number:
405-242-2788

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7988 , 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)