Provider Demographics
NPI:1871862870
Name:PLUMA CARE PRIVATE DUTY SERVICES, LLC.
Entity Type:Organization
Organization Name:PLUMA CARE PRIVATE DUTY SERVICES, LLC.
Other - Org Name:PETERS AGENCY HOSPICE AND PALLIATIVE CARE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO LHCA
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:ALES
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO - EXEC ADMINIST
Authorized Official - Phone:918-775-0100
Mailing Address - Street 1:P.O. BOX 886
Mailing Address - Street 2:926 E. CHEROKEE AVE.
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955
Mailing Address - Country:US
Mailing Address - Phone:918-775-6555
Mailing Address - Fax:918-775-6587
Practice Address - Street 1:926 E. CHEROKEE AVE.
Practice Address - Street 2:PETERS AGENCY HOSPICE AND PALLIATIVE CARE, LLC
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-775-6555
Practice Address - Fax:918-775-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251G00000X
OK4284251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based