Provider Demographics
NPI:1457387722
Name:HERITAGE ACQUISITION, LLC.
Entity Type:Organization
Organization Name:HERITAGE ACQUISITION, LLC.
Other - Org Name:HERITAGE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-840-7775
Mailing Address - Street 1:16212 SONOMA PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2117
Mailing Address - Country:US
Mailing Address - Phone:405-840-7775
Mailing Address - Fax:
Practice Address - Street 1:114 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-5273
Practice Address - Country:US
Practice Address - Phone:918-652-3919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4108251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
371566Medicare ID - Type UnspecifiedPROVIDER NUMBER