Provider Demographics
NPI:1104840784
Name:FULL LIFE HOSPICE, LLC
Entity Type:Organization
Organization Name:FULL LIFE HOSPICE, LLC
Other - Org Name:OKLAHOMA PALLIATIVE & HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-2659
Mailing Address - Street 1:908 SW 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5244
Mailing Address - Country:US
Mailing Address - Phone:405-418-2659
Mailing Address - Fax:405-488-1009
Practice Address - Street 1:908 SW 107TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5244
Practice Address - Country:US
Practice Address - Phone:405-418-2659
Practice Address - Fax:405-488-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4197251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-1649Medicare UPIN