Provider Demographics
NPI:1982998878
Name:HEAVEN AND EARTH HOSPICE LLC
Entity Type:Organization
Organization Name:HEAVEN AND EARTH HOSPICE LLC
Other - Org Name:ACG HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-932-2738
Mailing Address - Street 1:187 N CHURCH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5154
Mailing Address - Country:US
Mailing Address - Phone:800-932-2738
Mailing Address - Fax:888-847-9306
Practice Address - Street 1:1635 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-5368
Practice Address - Country:US
Practice Address - Phone:918-323-0100
Practice Address - Fax:918-323-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4164251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200108280AMedicaid
OK37D2051838OtherCLIA WAIVER
OK4164OtherSTATE LICENSE