Healthcare Provider Details

I. General information

NPI: 1770554065
Provider Name (Legal Business Name): GIRDNER'S PROFESSIONAL HOME HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N WALNUT ST
SALLISAW OK
74955-4438
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY STE 1100
DALLAS TX
75234-2712
US

V. Phone/Fax

Practice location:
  • Phone: 918-571-9009
  • Fax: 918-516-0700
Mailing address:
  • Phone: 800-379-1600
  • Fax: 903-537-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4098
License Number StateOK

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: COMPLIANCE,PRIVACY,&SAFETY OFFICER
Credential:
Phone: 517-768-4373