Provider Demographics
NPI:1487694816
Name:PONCA CITY HOMECARE SERVICES INC.
Entity type:Organization
Organization Name:PONCA CITY HOMECARE SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-765-8155
Mailing Address - Street 1:1209 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1746
Mailing Address - Country:US
Mailing Address - Phone:580-765-8155
Mailing Address - Fax:580-763-4549
Practice Address - Street 1:1900 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2035
Practice Address - Country:US
Practice Address - Phone:580-765-8155
Practice Address - Fax:580-763-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6-50843336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX ID NUMBER
OK=========0002OtherBCBS PROVIDER NUMBER