Provider Demographics
NPI:1699780445
Name:HEART & SOUL HEALTHCARE INC
Entity type:Organization
Organization Name:HEART & SOUL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BLAKELY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-942-6683
Mailing Address - Street 1:1900 N MACARTHUR BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127
Mailing Address - Country:US
Mailing Address - Phone:405-942-6683
Mailing Address - Fax:405-942-2246
Practice Address - Street 1:1900 N MACARTHUR BLVD
Practice Address - Street 2:STE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127
Practice Address - Country:US
Practice Address - Phone:405-942-6683
Practice Address - Fax:405-942-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7785251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000377679001OtherBLUE CROSS BLUE SHIELD
OK000377679001OtherBLUE CROSS BLUE SHIELD