MEDICARE: GOOD SHEPHERD HOSPICE OF ARDMORE, 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

General Provider Information

NPI Number	:	1194330811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD HOSPICE OF ARDMORE, LLC

Provider Business Mailing Address
First Line	:	4350 WILL ROGERS PKWY STE 400
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73108-1840
Country	:	US
Telephone Number	:	405-943-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 N COMMERCE ST STE 204
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1859
Country	:	US
Telephone Number	:	405-943-0903
Fax Number	:	405-943-0950

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JASON K DELESTER
Credential	:
Telephone Number	:	405-943-0903

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	10/03/2024

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