Provider Demographics
NPI:1801958244
Name:DAVID'S HEALTH CENTER, INC.
Entity type:Organization
Organization Name:DAVID'S HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-873-2876
Mailing Address - Street 1:200 N. MAIN ST.
Mailing Address - Street 2:P.O. BOX 116
Mailing Address - City:FORT TOWSON
Mailing Address - State:OK
Mailing Address - Zip Code:74735-0116
Mailing Address - Country:US
Mailing Address - Phone:580-873-2876
Mailing Address - Fax:580-873-2841
Practice Address - Street 1:200 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:FORT TOWSON
Practice Address - State:OK
Practice Address - Zip Code:74735-0116
Practice Address - Country:US
Practice Address - Phone:580-873-2876
Practice Address - Fax:580-873-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7384251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-7483Medicare ID - Type UnspecifiedHOME HEALTH AGENCY