Healthcare Provider Details

I. General information

NPI: 1609885466
Provider Name (Legal Business Name): FRONTIER HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 NW EXPRESSWAY STE 780
OKLAHOMA CITY OK
73112-1489
US

IV. Provider business mailing address

50 N LAURA ST STE 1800
JACKSONVILLE FL
32202-3664
US

V. Phone/Fax

Practice location:
  • Phone: 405-789-0541
  • Fax: 405-782-0541
Mailing address:
  • Phone: 904-493-6745
  • Fax: 904-262-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4107
License Number StateOK

VIII. Authorized Official

Name: MR. RICH FOGLE
Title or Position: CFO
Credential:
Phone: 904-493-6745