Provider Demographics
NPI:1326047762
Name:RED RIVER HOSPICE
Entity Type:Organization
Organization Name:RED RIVER HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ST. LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:NCICS, NCMAA
Authorized Official - Phone:405-943-8277
Mailing Address - Street 1:3525 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2801
Mailing Address - Country:US
Mailing Address - Phone:405-943-8277
Mailing Address - Fax:405-947-0158
Practice Address - Street 1:3525 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2801
Practice Address - Country:US
Practice Address - Phone:405-943-8277
Practice Address - Fax:405-947-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4128251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371551Medicare ID - Type UnspecifiedPROVIDER NUMBER
OK371590Medicare ID - Type UnspecifiedPROVIDER NUMBER FOR DUCAN