Provider Demographics
NPI:1699852186
Name:PORTICO HOSPICE OF OKLAHOMA, L.L.C.
Entity Type:Organization
Organization Name:PORTICO HOSPICE OF OKLAHOMA, L.L.C.
Other - Org Name:PORTICO HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HIGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-623-2774
Mailing Address - Street 1:9308 S WINSTON WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2710
Mailing Address - Country:US
Mailing Address - Phone:405-623-2774
Mailing Address - Fax:405-703-0503
Practice Address - Street 1:9308 S WINSTON WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2710
Practice Address - Country:US
Practice Address - Phone:405-623-2774
Practice Address - Fax:405-703-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based