Provider Demographics
NPI:1811089709
Name:HARBOR LIGHT HOSPICE LLC
Entity type:Organization
Organization Name:HARBOR LIGHT HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-3400
Mailing Address - Street 1:1000 W. CHOCTAW ROAD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2260
Mailing Address - Country:US
Mailing Address - Phone:405-224-3400
Mailing Address - Fax:405-224-3412
Practice Address - Street 1:1000 W. CHOCTAW ROAD
Practice Address - Street 2:SUITE 15
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73018-2260
Practice Address - Country:US
Practice Address - Phone:405-224-3400
Practice Address - Fax:405-224-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient