Organization Name: | HARBOR HOSPICE OF SOUTH TULSA LP |
NPI Number: | 1538547633 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRAD THIBODAUX (CHIEF DATA OFFICER) |
Mailing Address: | 3406 College St Suite 200 Beaumont |
State: | TX US |
Postal Code: | 777014612 |
Phone Number: | 4097302022 |
Fax Number: | 4092320573 |
NPI Enumeration Date: | 05/11/2015 |
NPI Last Update Date: | 12/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
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