NPIMap

Organization Active NPI

Complete Home Health of Tishomingo LLC

  • Home Health Agency
  • Tishomingo, OK
National Provider Identifier
1891116232
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
7830 Issued in OK
Legal business name
COMPLETE HOME HEALTH OF TISHOMINGO LLC
Practice address
315 N Western Ave
Tishomingo, OK 73460-4824
Phone
(580) 371-9300
NPI assigned
Jan 3, 2014
Last updated
Jun 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

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

Authorized official

Name
Lola Jane Edwards, RN BSN MS
Title
President
Phone
(803) 719-3005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 7830 OK Primary

Addresses

Primary practice location

315 N Western Ave
Tishomingo, OK 73460-4824

Mailing address

315 N Western Ave
Tishomingo, OK 73460-4824
Phone (580) 371-9300

Other identifiers 1

IdentifierTypeStateIssuer
7830OtherOKLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140313000612 OK Part A Provider - Home Health Agency 2769612704 Practice locations: Broken Bow, OK; Lawton, OK; Tishomingo, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891116232. Details of each certification follow.

Home health agency certification: CCN 377704

Legal name
COMPLETE HOME HEALTH OF TISHOMINGO LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 12, 2006
Last certification
Nov 16, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Dec 20, 2013 in OK
Enrollment address
315 N Western Avenue
Tishomingo, OK 73460-4824

Care Compare: Home health agency

Medicare Care Compare
Listed as
Complete Home Health of Tishomingo LLCCCN 377704 · All quality measures
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Dec 12, 2006
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
37D1054813Complete Home Health of Tishomingo, LLC315 N Western Avenue, Tishomingo, OK 73460Certificate of waiverMay 30, 2028

National Provider Directory

National Provider Directory

Locations

1230 SW 89th St
Ste B
Oklahoma City, OK 73139
Phone (405) 691-1333

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Iren Edwards Individual 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
W-2 Managing Employee Jan 1, 2014
Lola J Edwards Individual Corporate OfficerPresident Jul 6, 2015
W-2 Managing EmployeePresident / Administrator Jul 6, 2015

Practitioners & affiliated clinicians

Affiliated clinicians 79

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

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687478400000",
    "number": "1891116232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 N WESTERN AVE",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734604824",
            "telephone_number": "580-371-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 N WESTERN AVE",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734604824",
            "telephone_number": "580-371-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE HOME HEALTH OF TISHOMINGO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-03",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "LOLA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-719-3005",
        "authorized_official_credential": "RN BSN MS"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OK",
            "license": "7830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "7830",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, OK

Sources for this page

Verify at the official NPI Registry.