Healthcare Provider Details

I. General information

NPI: 1811089709
Provider Name (Legal Business Name): HARBOR LIGHT HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W. CHOCTAW ROAD SUITE 15
OKLAHOMA CITY OK
73018-2260
US

IV. Provider business mailing address

1000 W. CHOCTAW ROAD SUITE 15
OKLAHOMA CITY OK
73018-2260
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-3400
  • Fax: 405-224-3412
Mailing address:
  • Phone: 405-224-3400
  • Fax: 405-224-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: VIC SMITH
Title or Position: MANAGING PARTNER
Credential:
Phone: 405-224-3400