Provider Demographics
NPI:1861448508
Name:ROSS HOSPICE OF CHICKASHA LLC
Entity Type:Organization
Organization Name:ROSS HOSPICE OF CHICKASHA LLC
Other - Org Name:ELARA CARING VI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-537-8656
Mailing Address - Street 1:14295 MIDWAY ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001
Mailing Address - Country:US
Mailing Address - Phone:800-234-1866
Mailing Address - Fax:903-537-8420
Practice Address - Street 1:721 S GEORGE NIGH EXPY STE 3B
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7437
Practice Address - Country:US
Practice Address - Phone:405-224-0012
Practice Address - Fax:405-224-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4161251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200059300AMedicaid
75-3098244OtherHEALTH CHOICE
75-3098244OtherAETNA
OK200059300CMedicaid
75-3098244OtherFIRST HEALTH
000371617-001OtherBLUECROSSBLUESHIELD
75-3098244OtherHEALTH CHOICE