Provider Demographics
NPI:1487904728
Name:GOLDEN HEART SENIOR CARE OF OKLAHOMA
Entity type:Organization
Organization Name:GOLDEN HEART SENIOR CARE OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-796-4848
Mailing Address - Street 1:7301 BROADWAY EXT STE 118
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9045
Mailing Address - Country:US
Mailing Address - Phone:405-796-4848
Mailing Address - Fax:405-607-4881
Practice Address - Street 1:7301 BROADWAY EXT STE 118
Practice Address - Street 2:SUITE 118
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9045
Practice Address - Country:US
Practice Address - Phone:405-796-4848
Practice Address - Fax:405-607-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7999251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health