Provider Demographics
NPI:1043201890
Name:HOSPICE OF NORTH CENTRAL OKLAHOMA, INC
Entity Type:Organization
Organization Name:HOSPICE OF NORTH CENTRAL OKLAHOMA, INC
Other - Org Name:HOSPICE OF PONCA CITY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-762-9102
Mailing Address - Street 1:445 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1931
Mailing Address - Country:US
Mailing Address - Phone:580-762-9102
Mailing Address - Fax:580-765-3653
Practice Address - Street 1:445 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1931
Practice Address - Country:US
Practice Address - Phone:580-762-9102
Practice Address - Fax:580-765-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4003251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371517Medicare Oscar/Certification