1861632978 NPI number — NEIGHBORHOOD HOSPICE, LLC

Table of content: (NPI 1861632978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861632978 NPI number — NEIGHBORHOOD HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORHOOD HOSPICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPLETE HOSPICE CARE OF SOUTHERN OKLAHOMA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861632978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9005 S HUDSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74137-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-746-2595
Provider Business Mailing Address Fax Number:
580-746-2578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SW 11TH ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-746-2595
Provider Business Practice Location Address Fax Number:
580-746-2578
Provider Enumeration Date:
03/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
LOLA
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
803-516-5655

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4283 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HO4283 . This is a "LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com