Healthcare Provider Details

I. General information

NPI: 1134100142
Provider Name (Legal Business Name): PRAIRIE VIEW HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 MANVEL AVE SUITE C
CHANDLER OK
74834-4401
US

IV. Provider business mailing address

1206 MANVEL AVE SUITE C
CHANDLER OK
74834-4401
US

V. Phone/Fax

Practice location:
  • Phone: 405-258-0040
  • Fax: 405-258-0045
Mailing address:
  • Phone: 405-258-0040
  • Fax: 405-258-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number371624
License Number StateOK

VIII. Authorized Official

Name: PAULA KLUDING
Title or Position: DIRECTOR
Credential:
Phone: 405-258-0040