Provider Demographics
NPI:1487718011
Name:GREEN COUNTRY HOME HEALTH CARE INC
Entity type:Organization
Organization Name:GREEN COUNTRY HOME HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:918-783-5720
Mailing Address - Street 1:2738 E 51ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6271
Mailing Address - Country:US
Mailing Address - Phone:918-783-5720
Mailing Address - Fax:918-783-5760
Practice Address - Street 1:2738 E 51ST ST STE 240
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6271
Practice Address - Country:US
Practice Address - Phone:918-783-5720
Practice Address - Fax:918-783-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100627990BMedicaid
OK100627990AMedicaid
OK100627990CMedicaid