Provider Demographics
NPI:1588646749
Name:HOSPICE OF MCALESTER OKLAHOMA INC.
Entity Type:Organization
Organization Name:HOSPICE OF MCALESTER OKLAHOMA INC.
Other - Org Name:HOSPICE OF MCALESTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXUCUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-423-3911
Mailing Address - Street 1:PO BOX 1333
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1333
Mailing Address - Country:US
Mailing Address - Phone:918-423-3911
Mailing Address - Fax:918-423-4241
Practice Address - Street 1:801 E WYANDOTTE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5429
Practice Address - Country:US
Practice Address - Phone:918-423-3911
Practice Address - Fax:918-423-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4019251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKHO4019Medicaid
OKHO4019Medicaid