Provider Demographics
NPI:1922040385
Name:WALDRICH, INC.
Entity Type:Organization
Organization Name:WALDRICH, INC.
Other - Org Name:PREFERRED HOSPICE OF EDMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-721-8802
Mailing Address - Street 1:13204 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-3019
Mailing Address - Country:US
Mailing Address - Phone:405-721-8802
Mailing Address - Fax:405-721-8166
Practice Address - Street 1:122 N BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6303
Practice Address - Country:US
Practice Address - Phone:405-341-4883
Practice Address - Fax:405-844-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4117251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371571Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER