Provider Demographics
NPI:1053743294
Name:ALLY HOME HEALTH LLC
Entity type:Organization
Organization Name:ALLY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-574-4321
Mailing Address - Street 1:PO BOX R
Mailing Address - Street 2:
Mailing Address - City:BINGER
Mailing Address - State:OK
Mailing Address - Zip Code:73009-0179
Mailing Address - Country:US
Mailing Address - Phone:405-656-2203
Mailing Address - Fax:855-696-3030
Practice Address - Street 1:103 NORTH HERMANN AVE.
Practice Address - Street 2:
Practice Address - City:BINGER
Practice Address - State:OK
Practice Address - Zip Code:73009-0000
Practice Address - Country:US
Practice Address - Phone:405-656-2203
Practice Address - Fax:855-696-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC8020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200550780AMedicaid