Provider Demographics
NPI:1922007806
Name:COMPANION HOSPICE LLC
Entity Type:Organization
Organization Name:COMPANION HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-282-6285
Mailing Address - Street 1:1314 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3757
Mailing Address - Country:US
Mailing Address - Phone:405-282-3980
Mailing Address - Fax:405-282-3981
Practice Address - Street 1:1314 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3757
Practice Address - Country:US
Practice Address - Phone:405-282-3980
Practice Address - Fax:405-282-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4157251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371613Medicare ID - Type Unspecified