Provider Demographics
NPI:1174033393
Name:OAK CREEK HOSPICE LLC
Entity Type:Organization
Organization Name:OAK CREEK HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:916-628-2920
Mailing Address - Street 1:9580 OAK AVENUE PKWY STE 15
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1888
Mailing Address - Country:US
Mailing Address - Phone:916-458-5994
Mailing Address - Fax:916-545-2165
Practice Address - Street 1:9580 OAK AVENUE PKWY STE 15
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-1888
Practice Address - Country:US
Practice Address - Phone:916-458-5994
Practice Address - Fax:916-545-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based