| Organization Name: | ROSS HOSPICE OF PONCA CITY, LLC |
| NPI Number: | 1235242074 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREA FAIRBANKS (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 611 E Hartford Ave Ponca City |
| State: | OK US |
| Postal Code: | 746012006 |
| Phone Number: | 5807659090 |
| Fax Number: | 5807659117 |
| NPI Enumeration Date: | 08/16/2006 |
| NPI Last Update Date: | 06/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 4174 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |