Provider Demographics
NPI:1124073432
Name:SISTERLY CARE HEALTH SERVICES LLC.
Entity type:Organization
Organization Name:SISTERLY CARE HEALTH SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONAL OFFICER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-371-9300
Mailing Address - Street 1:708 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-1733
Mailing Address - Country:US
Mailing Address - Phone:580-371-9300
Mailing Address - Fax:580-371-2923
Practice Address - Street 1:708 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-1733
Practice Address - Country:US
Practice Address - Phone:580-371-9300
Practice Address - Fax:580-371-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377704Medicare Oscar/Certification