Provider Demographics
NPI:1194330811
Name:GOOD SHEPHERD HOSPICE OF ARDMORE, LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD HOSPICE OF ARDMORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:K
Authorized Official - Last Name:DELESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-0903
Mailing Address - Street 1:4350 WILL ROGERS PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1840
Mailing Address - Country:US
Mailing Address - Phone:405-943-0903
Mailing Address - Fax:
Practice Address - Street 1:1505 N COMMERCE ST STE 204
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1859
Practice Address - Country:US
Practice Address - Phone:405-943-0903
Practice Address - Fax:405-943-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based