Provider Demographics
NPI:1154414464
Name:SHARE HOME HEALTH LLC
Entity type:Organization
Organization Name:SHARE HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVEN
Authorized Official - Middle Name:CLELOAND
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-360-7014
Mailing Address - Street 1:508E CONFEDERATE STREET SUITE 104
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:OK
Mailing Address - Zip Code:74472-1703
Mailing Address - Country:US
Mailing Address - Phone:855-420-8225
Mailing Address - Fax:855-415-2862
Practice Address - Street 1:508E CONFEDERATE STREET SUITE 104
Practice Address - Street 2:
Practice Address - City:WHITEFIELD
Practice Address - State:OK
Practice Address - Zip Code:74472
Practice Address - Country:US
Practice Address - Phone:855-420-8225
Practice Address - Fax:855-415-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7282251E00000X
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699830CMedicaid
OK100699830DMedicaid
OK100699830CMedicaid
OK100699830DMedicaid
377176Medicare UPIN