Provider Demographics
NPI:1063733129
Name:AT HOME CARE HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:AT HOME CARE HOME HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:O
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:GERONTOLOGIST, MS
Authorized Official - Phone:405-843-2333
Mailing Address - Street 1:PO BOX 5961
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5961
Mailing Address - Country:US
Mailing Address - Phone:405-843-2333
Mailing Address - Fax:405-843-2344
Practice Address - Street 1:1901 N CLASSEN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6011
Practice Address - Country:US
Practice Address - Phone:405-843-2333
Practice Address - Fax:405-843-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7947251300000X, 251C00000X, 251J00000X, 251K00000X, 253Z00000X, 251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200472800AMedicaid
OKHC7947OtherHOME HEALTH CARE LICESED PROVIDER
OK377761Medicare Oscar/Certification
OKHC7947Medicare UPIN
OKHC7947OtherMEDICARE-CMS