NPIMap

Organization Active NPI

Ideal Home Care, LLC

  • Home Health Agency
  • Ardmore, OK
National Provider Identifier
1467430595
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
7781 Issued in OK
Legal business name
IDEAL HOME CARE, LLC
Practice address
2417 Chickasaw Blvd
Ardmore, OK 73401-1466
Phone
(580) 226-2323
Fax
(580) 226-2326
NPI assigned
Jan 9, 2006
Last updated
Oct 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Sherry Boatman, REGISTERED NURSE
Title
Administrator
Phone
(580) 226-2323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 7781 OK Primary

Addresses

Primary practice location

2417 Chickasaw Blvd
Ardmore, OK 73401-1466

Mailing address

2417 Chickasaw Blvd
Ardmore, OK 73401-1466
Phone (580) 226-2323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713000178 OK Part A Provider - Home Health Agency 2769460054 Practice locations: Healdton, OK; Durant, OK; Ardmore, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467430595. Details of each certification follow.

Home health agency certification: CCN 377678

Legal name
IDEAL HOME CARE, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 20, 2010
Last certification
Feb 26, 2019
Ownership / control type
Proprietary
Organization structure
OtherProprietary
Incorporated
May 4, 2004 in OK
Enrollment address
2417 Chickasaw Blvd
Ardmore, OK 73401-1466

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ideal Home Care, L.P.CCN 377678 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Jan 20, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D1026584Ideal Home Care LP2417 Chickasaw Blvd, Ardmore, OK 73401Certificate of waiverJun 8, 2028

National Provider Directory

National Provider Directory

Locations

2417 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-2323

2617 N Rockford Rd
Ardmore, OK 73401
Phone (580) 226-2323

2825 W University Blvd
Durant, OK 74701
Phone (580) 920-0600

603 Highway 70 N
Kingston, OK 73439
Phone (580) 564-9911

717 Highway 70 E
#C
Kingston, OK 73439
Phone (580) 564-9911

1101 E Wade Watts Ave
McAlester, OK 74501
Phone (918) 426-4900

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ideal Ardmore Investments LLC Organization, Norman, OK 5% Or Greater Direct Ownership Interest Sep 29, 2009
Sherry Boatman Individual 5% Or Greater Direct Ownership Interest May 4, 2004
5% Or Greater Indirect Ownership Interest Oct 5, 2009
General Partnership Interest May 4, 2004
Corporate Director May 4, 2004
W-2 Managing Employee May 4, 2004
Jacob Tynes Individual 5% Or Greater Direct Ownership Interest Oct 5, 2009
5% Or Greater Indirect Ownership Interest Jan 19, 2005
General Partnership Interest Oct 5, 2009
Corporate Director Oct 5, 2009
Vernon McKown Individual 5% Or Greater Direct Ownership Interest May 4, 2004
Corporate Director Jul 13, 2004
W-2 Managing Employee May 4, 2004

Practitioners & affiliated clinicians

Affiliated clinicians 49

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1467430595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2417 CHICKASAW BLVD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011466",
            "telephone_number": "580-226-2323",
            "fax_number": "580-226-2326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2417 CHICKASAW BLVD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011466",
            "telephone_number": "580-226-2323",
            "fax_number": "580-226-2326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "BOATMAN",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "580-226-2323",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OK",
            "license": "7781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.