Provider Demographics
NPI:1881767564
Name:21ST CENTURY HOME HEALTH AGENCY
Entity type:Organization
Organization Name:21ST CENTURY HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:405-348-3459
Mailing Address - Street 1:1421 NW 150TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1305
Mailing Address - Country:US
Mailing Address - Phone:405-348-3459
Mailing Address - Fax:405-348-4234
Practice Address - Street 1:1421 NW 150TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1305
Practice Address - Country:US
Practice Address - Phone:405-348-3459
Practice Address - Fax:405-348-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7609251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377614Medicare Oscar/Certification