MEDICARE: COMPASSIONATE CARE 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	251E00000X	Home Health Agency	4148	OK

General Provider Information

NPI Number	:	1548263197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE HOSPICE LLC

Provider Business Mailing Address
First Line	:	618 NW 32ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7343
Country	:	US
Telephone Number	:	405-948-4357
Fax Number	:	405-605-2276

Provider Business Practice Location Address
First Line	:	618 NW 32ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7343
Country	:	US
Telephone Number	:	405-948-4357
Fax Number	:	405-605-2276

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICKEY JEAN KEY
Credential	:
Telephone Number	:	405-948-4357

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/22/2020

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