Healthcare Provider Details

I. General information

NPI: 1255179966
Provider Name (Legal Business Name): ENNOBLE HOSPICE OK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W HEFNER RD
OKLAHOMA CITY OK
73114-6631
US

IV. Provider business mailing address

101 W HEFNER RD
OKLAHOMA CITY OK
73114-6631
US

V. Phone/Fax

Practice location:
  • Phone: 405-438-3236
  • Fax: 405-415-4261
Mailing address:
  • Phone: 405-438-3236
  • Fax: 405-415-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KUSHABHADRA DAS
Title or Position: CEO
Credential:
Phone: 862-812-9010