Provider Demographics
NPI:1649412396
Name:SHEPHERD HOME HEALTH & HOSPICE LLC
Entity Type:Organization
Organization Name:SHEPHERD HOME HEALTH & HOSPICE LLC
Other - Org Name:SHEPHERD HOME HEALTH LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/ ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:BS MT
Authorized Official - Phone:580-323-1580
Mailing Address - Street 1:812 W GARY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-2720
Mailing Address - Country:US
Mailing Address - Phone:580-323-1580
Mailing Address - Fax:580-323-2581
Practice Address - Street 1:812 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2720
Practice Address - Country:US
Practice Address - Phone:580-323-1580
Practice Address - Fax:580-323-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200114810AMedicaid
OK200114810AMedicaid