=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376606376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE'S JOURNEY HOSPICE, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 N 4TH AVE
-----------------------------------------------------
City | STROUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74079-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-968-4870
-----------------------------------------------------
Fax | 918-968-0464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 N 4TH AVE
-----------------------------------------------------
City | STROUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74079-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-968-4870
-----------------------------------------------------
Fax | 918-968-0464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BILLY RAY HUFF JR.
-----------------------------------------------------
Credential | CRT, RCP
-----------------------------------------------------
Telephone | 918-968-4870
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 4166
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------