Provider Demographics
NPI:1013348440
Name:A PATH OF CARE HOSPICE I, LLC
Entity Type:Organization
Organization Name:A PATH OF CARE HOSPICE I, LLC
Other - Org Name:TENDERCARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-2727
Mailing Address - Street 1:2910 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1023
Mailing Address - Country:US
Mailing Address - Phone:405-928-2727
Mailing Address - Fax:405-928-2720
Practice Address - Street 1:4251 28TH AVE NW
Practice Address - Street 2:SUITE 111
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6207
Practice Address - Country:US
Practice Address - Phone:405-928-9900
Practice Address - Fax:405-928-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4199251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371666Medicare Oscar/Certification