Basic Information
| Provider Information | |||||||||
| NPI: | 1437581303 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANCTUARY HOSPICE, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1214 E 33RD ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741052018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188943487 | ||||||||
| FaxNumber: | 9187129880 | ||||||||
| Practice Location | |||||||||
| Address1: | 38099 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347445091 | ||||||||
| FaxNumber: | 7347445092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2013 | ||||||||
| LastUpdateDate: | 08/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUHN | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9188943487 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | L2531357 | MI | Y | Agencies | Hospice Care, Community Based |
No ID Information.