| Organization Name: | SHEPHERD'S CARE HOSPICE OF WAGONER, LLC |
| NPI Number: | 1912960089 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEENA K. BOTTOM (PRESIDENT) |
| Mailing Address: | 611 W Cherokee St Wagoner |
| State: | OK US |
| Postal Code: | 744674618 |
| Phone Number: | 9184854673 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 4177 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |