Provider Demographics
NPI:1063149862
Name:CQM ACQUISITION COMPANY LLC
Entity type:Organization
Organization Name:CQM ACQUISITION COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-778-4008
Mailing Address - Street 1:1501 NW 189TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3317
Mailing Address - Country:US
Mailing Address - Phone:405-778-4008
Mailing Address - Fax:
Practice Address - Street 1:222 E EUFAULA ST STE 210
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6080
Practice Address - Country:US
Practice Address - Phone:405-310-2756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care