Healthcare Provider Details

I. General information

NPI: 1245347632
Provider Name (Legal Business Name): CARTER HEALTHCARE HOSPICE OF EAST OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HARRIS CIR STE A
TAHLEQUAH OK
74464-8899
US

IV. Provider business mailing address

7725 W RENO AVE STE 332
OKLAHOMA CITY OK
73127-9799
US

V. Phone/Fax

Practice location:
  • Phone: 918-458-0663
  • Fax: 918-428-0780
Mailing address:
  • Phone: 405-947-7700
  • Fax: 405-947-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4153
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JUSTIN CARTER
Title or Position: AUTHORIZED OFFICIAL/PRESIDENT
Credential:
Phone: 405-947-7700