Provider Demographics
NPI:1598736712
Name:PROFESSIONAL HOME HOSPICE OF MUSKOGEE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME HOSPICE OF MUSKOGEE, INC.
Other - Org Name:ELARA CARING XIV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE AND PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONASTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-379-1600
Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2712
Mailing Address - Country:US
Mailing Address - Phone:800-379-1600
Mailing Address - Fax:903-537-8470
Practice Address - Street 1:4815 S HARVARD AVE STE 300A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3055
Practice Address - Country:US
Practice Address - Phone:918-683-9400
Practice Address - Fax:918-351-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4155251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200046590AMedicaid
OK200046590AMedicaid