MEDICARE: FULL LIFE HOSPICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	4197	OK

General Provider Information

NPI Number	:	1104840784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL LIFE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	908 SW 107TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5244
Country	:	US
Telephone Number	:	405-418-2659
Fax Number	:	405-488-1009

Provider Business Practice Location Address
First Line	:	908 SW 107TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5244
Country	:	US
Telephone Number	:	405-418-2659
Fax Number	:	405-488-1009

Authorized Official
Title or Position	:	CEO
Name	:	RYAN CURTIS GRUHALA
Credential	:
Telephone Number	:	573-220-4073

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	04/08/2025

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