Provider Demographics
NPI:1861758468
Name:HEALTHCARE INNOVATIONS IN-HOME SERVICES OF OKLAHOMA CITY , LLC
Entity type:Organization
Organization Name:HEALTHCARE INNOVATIONS IN-HOME SERVICES OF OKLAHOMA CITY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /ADMINISTARTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-537-8629
Mailing Address - Street 1:4300 HIGHLINE BLVD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1830
Mailing Address - Country:US
Mailing Address - Phone:405-949-9984
Mailing Address - Fax:405-949-0121
Practice Address - Street 1:4300 HIGHLINE BLVD
Practice Address - Street 2:SUITE C280
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1830
Practice Address - Country:US
Practice Address - Phone:405-949-9984
Practice Address - Fax:405-949-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7611251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-7648OtherMEDICARE P-TAN