Healthcare Provider Details

I. General information

NPI: 1295736866
Provider Name (Legal Business Name): INTEGRIS HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13920 QUAILBROOK DR
OKLAHOMA CITY OK
73134-1718
US

IV. Provider business mailing address

PO BOX 96014
OKLAHOMA CITY OK
73196-0514
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-5557
  • Fax:
Mailing address:
  • Phone: 405-848-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4064
License Number StateOK

VIII. Authorized Official

Name: BRENT DAVIS
Title or Position: VICE PRESIDENT
Credential:
Phone: 405-949-3774