MEDICARE: MY BROTHERS KEEPER SERVICES UNLIMITED 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	4220	OK

General Provider Information

NPI Number	:	1801828215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY BROTHERS KEEPER SERVICES UNLIMITED INC.

Provider Business Mailing Address
First Line	:	2120 S 85TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3012
Country	:	US
Telephone Number	:	918-622-3800
Fax Number	:	918-622-1574

Provider Business Practice Location Address
First Line	:	2120 S 85TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-3012
Country	:	US
Telephone Number	:	918-622-3800
Fax Number	:	918-622-1574

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	MR. DAVID NEAL CARSON
Credential	:
Telephone Number	:	918-622-3800

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/22/2020

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