1295842664 NPI number — CARTER HEALTHCARE HOSPICE OF NORTHEAST OKLAHOMA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295842664 NPI number — CARTER HEALTHCARE HOSPICE OF NORTHEAST OKLAHOMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARTER HEALTHCARE HOSPICE OF NORTHEAST OKLAHOMA, 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:
Provider Other Organization Name Type Code:
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:
1295842664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7725 W RENO AVE STE 332
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73127-9799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-947-7700
Provider Business Mailing Address Fax Number:
405-947-7300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6630 E 121ST ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BIXBY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-425-4000
Provider Business Practice Location Address Fax Number:
918-428-0780
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/PRESIDENT
Authorized Official Telephone Number:
405-947-7700

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4042 , 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)





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