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General NPI Number Information
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NPI Number | 1306213293
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Entity Type | Organization
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Legal Business Name | LIMITED LIABILITY CORPORATION
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 8524 S WESTERN AVE STE 109
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-9247
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Country | US
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Telephone | 405-915-7245
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Fax | 405-913-1200
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Provider Business Mailing Address
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Address Line | 17105 BETHEL RD STE A
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City | SHAWNEE
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State | OK
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Zip | 74801-2938
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Country | US
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Telephone | 405-915-7245
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Fax | 844-272-8001
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANGELA D OVERLEY
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Credential |
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Telephone | 405-915-7245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | H04302
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License Number State | OK
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