MEDICARE: HEAVEN AND EARTH HOSPICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	4164	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	37D2051838	OTHER	OK	CLIA WAIVER
3	4164	OTHER	OK	STATE LICENSE

General Provider Information

NPI Number	:	1982998878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVEN AND EARTH HOSPICE LLC

Provider Business Mailing Address
First Line	:	187 N CHURCH ST STE 201
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-5154
Country	:	US
Telephone Number	:	800-932-2738
Fax Number	:	888-847-9306

Provider Business Practice Location Address
First Line	:	1635 S MAIN ST
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-5368
Country	:	US
Telephone Number	:	918-323-0100
Fax Number	:	918-323-0131

Authorized Official
Title or Position	:	CCO
Name	:	PAMELA DUNCAN
Credential	:
Telephone Number	:	800-932-2738

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	01/29/2024

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