Provider Demographics
NPI:1780738484
Name:HOSPICE OF NORTHEAST OKLAHOMA, LLC
Entity type:Organization
Organization Name:HOSPICE OF NORTHEAST OKLAHOMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-622-9281
Mailing Address - Street 1:PO BOX 781097
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-1097
Mailing Address - Country:US
Mailing Address - Phone:316-260-9690
Mailing Address - Fax:316-440-5562
Practice Address - Street 1:4111 S DARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6348
Practice Address - Country:US
Practice Address - Phone:918-622-9281
Practice Address - Fax:918-513-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based