Healthcare Provider Details

I. General information

NPI: 1326046566
Provider Name (Legal Business Name): HOMETOWN HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 S YORK ST
MUSKOGEE OK
74403-8876
US

IV. Provider business mailing address

2307 S YORK ST
MUSKOGEE OK
74403-8876
US

V. Phone/Fax

Practice location:
  • Phone: 918-681-4440
  • Fax: 918-681-4428
Mailing address:
  • Phone: 918-681-4440
  • Fax: 918-681-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4059
License Number StateOK

VIII. Authorized Official

Name: MRS. ELIZABETH E. JONES
Title or Position: ACCOUNTING COORDINATOR
Credential:
Phone: 918-681-4440