Provider Demographics
NPI:1780966283
Name:COUNTRY STYLE HEALTH CARE, INC.XII
Entity type:Organization
Organization Name:COUNTRY STYLE HEALTH CARE, INC.XII
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-2626
Mailing Address - Street 1:9160 NW HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-5306
Mailing Address - Country:US
Mailing Address - Phone:918-465-2626
Mailing Address - Fax:918-465-0042
Practice Address - Street 1:1100 E MELTON DR
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-2700
Practice Address - Country:US
Practice Address - Phone:918-253-8522
Practice Address - Fax:918-253-8548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTRY STYLE HEALTH CARE,INC. XII DBA OKLA. HEALTHCARE SOLUTIONS XII
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-12
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7971251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health