MEDICARE: HARBOR LIGHT 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	315D00000X	Inpatient Hospice

General Provider Information

NPI Number	:	1811089709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR LIGHT HOSPICE LLC

Provider Business Mailing Address
First Line	:	1000 W. CHOCTAW ROAD
Second Line	:	SUITE 15
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73018-2260
Country	:	US
Telephone Number	:	405-224-3400
Fax Number	:	405-224-3412

Provider Business Practice Location Address
First Line	:	1000 W. CHOCTAW ROAD
Second Line	:	SUITE 15
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73018-2260
Country	:	US
Telephone Number	:	405-224-3400
Fax Number	:	405-224-3412

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	VIC SMITH
Credential	:
Telephone Number	:	405-224-3400

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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