Organization
AT HOME SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA ANN GRAGG LPN (CO-OWNER)
(918) 760-1122
Entity
Organization
Contact information
Practice address
177 GRANADA DRIVE, MANNFORD, OK 74044
(918) 760-1122
(918) 865-2558
Mailing address
PO BOX 481, MANNFORD, OK 74044-0481
(918) 760-1122
(918) 865-2558
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/22/2007
Last updated
08/22/2020
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