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General NPI Number Information
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NPI Number | 1740339548
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOSPICE LLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 4110 S ROCKFORD AVE STE 201
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City | TULSA
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State | OK
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Zip | 74105-4251
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Country | US
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Telephone | 918-250-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 4110 S ROCKFORD AVE STE 201
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City | TULSA
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State | OK
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Zip | 74105-4251
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Country | US
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Telephone | 918-250-5555
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Fax |
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Authorized Official
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Title or Position | CHIEF STRATGEGY OFFICER
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Name | HAYLEY J HUGHES
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Credential |
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Telephone | 918-250-5555
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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 | 4194
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License Number State | OK
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