1861448508 NPI number — ROSS HOSPICE OF CHICKASHA LLC

Table of content: (NPI 1861448508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861448508 NPI number — ROSS HOSPICE OF CHICKASHA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS HOSPICE OF CHICKASHA 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:
ELARA CARING VI
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:
1861448508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14295 MIDWAY ROAD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-234-1866
Provider Business Mailing Address Fax Number:
903-537-8420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 S GEORGE NIGH EXPY STE 3B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALESTER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74501-7437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-224-0012
Provider Business Practice Location Address Fax Number:
405-224-2974
Provider Enumeration Date:
05/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF REGULATORY
Authorized Official Telephone Number:
903-537-8656

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4161 , 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: 200059300A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75-3098244 . This is a "HEALTH CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75-3098244 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200059300C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75-3098244 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000371617-001 . This is a "BLUECROSSBLUESHIELD" identifier . This identifiers is of the category "OTHER".