Provider Demographics
NPI:1962761833
Name:MILLENNIUM HOSPICE, INC.
Entity type:Organization
Organization Name:MILLENNIUM HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-493-6555
Mailing Address - Street 1:12129 E. SKELLY DR.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-2410
Mailing Address - Country:US
Mailing Address - Phone:918-493-6555
Mailing Address - Fax:918-488-8825
Practice Address - Street 1:12129 E. SKELLY DR.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-2410
Practice Address - Country:US
Practice Address - Phone:918-493-6555
Practice Address - Fax:918-488-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based