MEDICARE: PRAIRIE VIEW HOSPICE, INC.

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	371624	OK

General Provider Information

NPI Number	:	1134100142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAIRIE VIEW HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1206 MANVEL AVE
Second Line	:	SUITE C
City	:	CHANDLER
State	:	OK
Zip	:	74834-4401
Country	:	US
Telephone Number	:	405-258-0040
Fax Number	:	405-258-0045

Provider Business Practice Location Address
First Line	:	1206 MANVEL AVE
Second Line	:	SUITE C
City	:	CHANDLER
State	:	OK
Zip	:	74834-4401
Country	:	US
Telephone Number	:	405-258-0040
Fax Number	:	405-258-0045

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PAULA KLUDING
Credential	:
Telephone Number	:	405-258-0040

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/09/2012

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