Provider Demographics
NPI:1881883148
Name:THREE RIVERS CONSULTING & MANAGEMENT ,LLC
Entity type:Organization
Organization Name:THREE RIVERS CONSULTING & MANAGEMENT ,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:805-584-6608
Mailing Address - Street 1:621 S PARK DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-5331
Mailing Address - Country:US
Mailing Address - Phone:580-351-6577
Mailing Address - Fax:580-501-0853
Practice Address - Street 1:621 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-5331
Practice Address - Country:US
Practice Address - Phone:805-501-0850
Practice Address - Fax:580-501-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37-1692251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-1692Medicare UPIN