Provider Demographics
NPI:1689637381
Name:FAMILY FAITH HOSPICE, INC.
Entity Type:Organization
Organization Name:FAMILY FAITH HOSPICE, INC.
Other - Org Name:FAITH HOSPICE OF SW OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-330-2300
Mailing Address - Street 1:921 NW 164TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1051
Mailing Address - Country:US
Mailing Address - Phone:405-330-2300
Mailing Address - Fax:405-330-2305
Practice Address - Street 1:1836 NW 52ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3122
Practice Address - Country:US
Practice Address - Phone:580-353-2711
Practice Address - Fax:580-353-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4125251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200087110 AMedicaid
OK37-1587Medicare Oscar/Certification