Organization
INDIAN TERRITORY LONG TERM CARE, INC.
Active
Organization
INDIAN TERRITORY LONG TERM CARE, INC.
Active
Other names
Indian Territory Provider Care PLus
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHONDA GAIL HENDRIX MSARNPC (OWNER)
(580) 371-2106
Entity
Organization
Contact information
Practice address
105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
(580) 371-0015
Mailing address
105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
(580) 371-0015
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
100627980A
OK
253Z00000X
In Home Supportive Care Agency
100627980E
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100627980A
—
OK
05
—
100627980E
—
OK
Enumeration date
09/20/2006
Last updated
11/20/2008
Update your record
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