Share Home Health LLC
Organization Active NPI Home Health Agency · Whitefield, OK
NPI 1154414464 · NPPES record last updated Jul 17, 2014
Key facts
- NPI
- 1154414464
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- SHARE HOME HEALTH LLC
- Practice address
- 508E Confederate Street Suite 104
Whitefield, OK 74472 - Phone
- (855) 420-8225
- Fax
- (855) 415-2862
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Iven Cleloand Edwards
- Title
- Ceo, Owner
- Phone
- (918) 360-7014
Corporate family (same tax ID) 1
Affiliated clinicians 6
-
Gina Clark, DO
-
Chad E Crawley, D.O.
-
Danya Julson, D.O.
-
Justin Scott Reid, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Complete Home Health of Stigler
- Overall star rating
- ★★☆☆☆ 2 of 5
- Ownership
- Proprietary
- Certified
- Sep 18, 1989
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2073278 | Share Home Health LLC | Certificate of waiver | Jul 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Home health agency certification: CCN 377166
- Legal name
- SHARE HOME HEALTH LLC
- Doing business as
- COMPLETE HOME HEALTH OF STIGLER
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Sep 18, 1989
- Last certification
- Mar 17, 2021
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 8, 2013 in OK
- Enrollment address
- 806 N Main
Stigler, OK 74462-2773
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Iren Edwards |
5% Or Greater Direct Ownership Interest | Aug 1, 2013 | |
| Dona Almack |
W-2 Managing Employee |
Aug 1, 2013 | |
| Lola J Edwards |
Corporate Officer |
Jul 6, 2015 | 100% |
| Corporate Director |
Jul 31, 2013 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131028002031 | OK | Part a Provider - Home Health Agency | 9638304603 | Practice locations: Stigler, OK |
National Provider Directory
- Tax ID family
- Complete Home Health of Stigler
Locations
205 E Main St
Stigler, OK 74462
Phone (855) 420-8225
508 E Confederate St
Unit 104
Whitefield, OK 74472
Phone (855) 420-8225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 7282 | OK | |
| Home Health Agency | 251E00000X | OK | Yes |
Addresses
Primary practice location
508E Confederate Street Suite 104
Whitefield, OK 74472
Mailing address
508E Confederate Street Suite 104
Whitefield, OK 74472-1703
Phone (855) 420-8225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100699830C | Medicaid | OK | |
| 100699830D | Medicaid | OK |
Other names
- Complete Home Health of Stigler
NPI Registry JSON
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1405555200000",
"number": "1154414464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "508E CONFEDERATE STREET SUITE 104",
"city": "WHITEFIELD",
"state": "OK",
"postal_code": "744721703",
"telephone_number": "855-420-8225",
"fax_number": "855-415-2862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508E CONFEDERATE STREET SUITE 104",
"city": "WHITEFIELD",
"state": "OK",
"postal_code": "74472",
"telephone_number": "855-420-8225",
"fax_number": "855-415-2862"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHARE HOME HEALTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-02",
"last_updated": "2014-07-17",
"status": "A",
"authorized_official_last_name": "EDWARDS",
"authorized_official_first_name": "IVEN",
"authorized_official_middle_name": "CLELOAND",
"authorized_official_title_or_position": "CEO, OWNER",
"authorized_official_telephone_number": "918-360-7014"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "OK",
"license": "7282",
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "OK",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100699830C",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100699830D",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Complete Home Health of Stigler",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Whitefield, OK
All providers in Whitefield, OK · Home Health Agency in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.