Provider Demographics
NPI:1700104718
Name:GOOD SHEPHERD HOSPICE OF MID-AMERICA INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOSPICE OF MID-AMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DELESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-0903
Mailing Address - Street 1:4350 WILL ROGERS PKWY
Mailing Address - Street 2:STE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1826
Mailing Address - Country:US
Mailing Address - Phone:405-943-0903
Mailing Address - Fax:405-943-0950
Practice Address - Street 1:11267 STANG LINE ROAD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4040
Practice Address - Country:US
Practice Address - Phone:816-822-2292
Practice Address - Fax:816-822-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10404900BMedicaid