Provider Demographics
NPI:1750545554
Name:HEALTHBACK OF CENTRAL OKLAHOMA, INC.
Entity type:Organization
Organization Name:HEALTHBACK OF CENTRAL OKLAHOMA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:W
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-1700
Mailing Address - Street 1:16211 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8871
Mailing Address - Country:US
Mailing Address - Phone:405-842-1700
Mailing Address - Fax:405-767-1695
Practice Address - Street 1:111 PATTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2046
Practice Address - Country:US
Practice Address - Phone:580-762-5800
Practice Address - Fax:580-762-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200095690AMedicaid
OK377538Medicare Oscar/Certification