Provider Demographics
NPI:1730283953
Name:PENTATWO LLC
Entity Type:Organization
Organization Name:PENTATWO LLC
Other - Org Name:APEX HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LENN
Authorized Official - Last Name:CHARBONEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-848-3779
Mailing Address - Street 1:8241 S WALKER AVE STE 152
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9464
Mailing Address - Country:US
Mailing Address - Phone:405-848-3779
Mailing Address - Fax:405-607-4678
Practice Address - Street 1:8241 S WALKER AVE STE 152
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9464
Practice Address - Country:US
Practice Address - Phone:405-848-3779
Practice Address - Fax:405-607-4678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4024251G00000X
OKH4024251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371522Medicare ID - Type Unspecified