Provider Demographics
NPI:1386956456
Name:HEALTHBACK HOME HEALTH OF EASTERN OKLAHOMA, INC.
Entity type:Organization
Organization Name:HEALTHBACK HOME HEALTH OF EASTERN OKLAHOMA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-1700
Mailing Address - Street 1:16211 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8871
Mailing Address - Country:US
Mailing Address - Phone:405-842-1700
Mailing Address - Fax:405-767-1695
Practice Address - Street 1:401 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2331
Practice Address - Country:US
Practice Address - Phone:918-967-8095
Practice Address - Fax:918-967-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7164251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700850FMedicaid
OK100700850FMedicaid