MEDICARE: ONHL HOSPICE SERVICES, 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	315D00000X	Inpatient Hospice	4259	OK

General Provider Information

NPI Number	:	1780608307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONHL HOSPICE SERVICES, LLC

Provider Business Mailing Address
First Line	:	701 N BRISTOW
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-2442
Country	:	US
Telephone Number	:	918-352-3080
Fax Number	:	918-352-9014

Provider Business Practice Location Address
First Line	:	701 N BRISTOW
Second Line	:
City	:	DRUMRIGHT
State	:	OK
Zip	:	74030-2442
Country	:	US
Telephone Number	:	918-352-3080
Fax Number	:	918-352-9014

Authorized Official
Title or Position	:	BUSINESS MANAGEMENT
Name	:	MR. JUSTIN MCGREW
Credential	:
Telephone Number	:	918-775-4439

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/19/2008

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