Provider Demographics
NPI:1528463676
Name:CARTER HEALTHCARE OF WESTERN OKLAHOMA, LLC
Entity type:Organization
Organization Name:CARTER HEALTHCARE OF WESTERN OKLAHOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-7700
Mailing Address - Street 1:3105 S MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119-1022
Mailing Address - Country:US
Mailing Address - Phone:405-947-7700
Mailing Address - Fax:405-947-7300
Practice Address - Street 1:2510 W CHESTNUT AVE STE D
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3906
Practice Address - Country:US
Practice Address - Phone:580-237-3672
Practice Address - Fax:580-237-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377189Medicare Oscar/Certification