Provider Demographics
NPI:1194081547
Name:PETERS AGENCY HOSPICE AND PALLITATIVE CARE, LLC
Entity type:Organization
Organization Name:PETERS AGENCY HOSPICE AND PALLITATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:ALES
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN MBA CCRN-R CCM LH
Authorized Official - Phone:918-775-0100
Mailing Address - Street 1:P.O. BOX 886
Mailing Address - Street 2:1015 E CHOCTAW
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955
Mailing Address - Country:US
Mailing Address - Phone:918-790-7555
Mailing Address - Fax:918-790-7587
Practice Address - Street 1:1015 E. CHOCTAW
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-790-7555
Practice Address - Fax:918-790-7587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETERS AGENCY CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health