MEDICARE: SUNCREST HOSPICE TULSA 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	:	1629645247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCREST HOSPICE TULSA LLC

Provider Business Mailing Address
First Line	:	9800 S MONROE ST STE 900
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4419
Country	:	US
Telephone Number	:	801-849-0486
Fax Number	:	801-849-0476

Provider Business Practice Location Address
First Line	:	4555 S HARVARD AVE STE C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2915
Country	:	US
Telephone Number	:	918-221-6366
Fax Number	:	918-922-7470

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER HARRIS
Credential	:
Telephone Number	:	801-849-0486

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	07/01/2026

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