Provider Demographics
NPI:1336163013
Name:PENTADOYEN LLC
Entity type:Organization
Organization Name:PENTADOYEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHARBONEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-525-0118
Mailing Address - Street 1:8241 S WALKER AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9401
Mailing Address - Country:US
Mailing Address - Phone:405-525-0118
Mailing Address - Fax:405-525-3172
Practice Address - Street 1:8241 S WALKER AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9401
Practice Address - Country:US
Practice Address - Phone:405-525-0118
Practice Address - Fax:405-525-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7825251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377709Medicare Oscar/Certification