Provider Demographics
NPI:1972901155
Name:COMPLETECARE PRIVATE SERVICES, LLC
Entity type:Organization
Organization Name:COMPLETECARE PRIVATE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:2401 TEE CIR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6207
Mailing Address - Country:US
Mailing Address - Phone:405-928-2727
Mailing Address - Fax:405-928-2720
Practice Address - Street 1:301 N 2ND ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4657
Practice Address - Country:US
Practice Address - Phone:918-302-3300
Practice Address - Fax:918-302-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health