Provider Demographics
NPI:1194957514
Name:DIRECTIONS OF CHANGE LLC
Entity type:Organization
Organization Name:DIRECTIONS OF CHANGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EISENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-245-5908
Mailing Address - Street 1:1025 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-8110
Mailing Address - Country:US
Mailing Address - Phone:918-245-5908
Mailing Address - Fax:918-245-3079
Practice Address - Street 1:1025 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-8110
Practice Address - Country:US
Practice Address - Phone:918-245-5908
Practice Address - Fax:918-245-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7217-7217314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375285Medicare Oscar/Certification