Provider Demographics
NPI:1023470515
Name:OAKLODGES, LLC
Entity type:Organization
Organization Name:OAKLODGES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CHIEF FINANCIAL OFF
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:620-251-6700
Mailing Address - Street 1:201 W 8TH ST
Mailing Address - Street 2:P.O. BOX 509
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-5807
Mailing Address - Country:US
Mailing Address - Phone:620-251-6700
Mailing Address - Fax:
Practice Address - Street 1:820 SPELLMAN CIR
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-7492
Practice Address - Country:US
Practice Address - Phone:785-632-3193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS177072Medicare UPIN