MEDICARE: ANGELS OF MERCY 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	251G00000X	Community Based Hospice Care Agency		OK

General Provider Information

NPI Number	:	1881747616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS OF MERCY HOSPICE, LLC.

Provider Business Mailing Address
First Line	:	13204 N MACARTHUR BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-3019
Country	:	US
Telephone Number	:	405-720-3115
Fax Number	:	405-720-8555

Provider Business Practice Location Address
First Line	:	4005 NW EXPRESSWAY ST
Second Line	:	605-B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1691
Country	:	US
Telephone Number	:	405-720-3115
Fax Number	:	405-720-8555

Authorized Official
Title or Position	:	MANAGER OWNER
Name	:	BRANDON D LOWDER
Credential	:
Telephone Number	:	405-720-3115

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/29/2008

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