Provider Demographics
NPI:1205251352
Name:HUMANITY HOSPICE, LLC
Entity type:Organization
Organization Name:HUMANITY HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-2530
Mailing Address - Street 1:1109 N BRYANT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3263
Mailing Address - Country:US
Mailing Address - Phone:405-418-2530
Mailing Address - Fax:405-418-2540
Practice Address - Street 1:1109 N BRYANT AVE STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3263
Practice Address - Country:US
Practice Address - Phone:405-418-2530
Practice Address - Fax:405-418-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based