Healthcare Provider Details

I. General information

NPI: 1124229125
Provider Name (Legal Business Name): FREEDOM HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 S SHERIDAN RD SUITE 102
TULSA OK
74133-1756
US

IV. Provider business mailing address

6666 S SHERIDAN RD SUITE 102
TULSA OK
74133-1756
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-4930
  • Fax: 918-346-6400
Mailing address:
  • Phone: 918-493-4930
  • Fax: 918-346-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number371657
License Number StateOK

VIII. Authorized Official

Name: SHERRILL KAYE DEJACIMO
Title or Position: QUALITY ASSURANCE
Credential:
Phone: 918-493-4930