| Organization Name: | PATRIA HEALTHCARE, LLC |
| NPI Number: | 1558514331 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHERRY J CROCKETT (ADMINISTRATOR) |
| Mailing Address: | 201 W Okmulgee Ave Checotah |
| State: | OK US |
| Postal Code: | 744262413 |
| Phone Number: | 9184730505 |
| Fax Number: | 9184730705 |
| NPI Enumeration Date: | 10/24/2008 |
| NPI Last Update Date: | 09/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 4218 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |