Provider Demographics
NPI:1861494759
Name:COUNTRY STYLE HEALTH CARE INC VII
Entity type:Organization
Organization Name:COUNTRY STYLE HEALTH CARE INC VII
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-539-2427
Mailing Address - Street 1:2301 HIGHWAY 1187 STE 203
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6139
Mailing Address - Country:US
Mailing Address - Phone:817-539-2427
Mailing Address - Fax:817-549-4150
Practice Address - Street 1:824 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3834
Practice Address - Country:US
Practice Address - Phone:918-647-5100
Practice Address - Fax:918-649-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7672251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262710AMedicaid
OK377627Medicare Oscar/Certification