Basic Information
| Provider Information | |||||||||
| NPI: | 1609885466 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FRONTIER HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FRONTIER HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 N LAURA ST | ||||||||
| Address2: | STE 1800 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322023664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044936745 | ||||||||
| FaxNumber: | 9042627443 | ||||||||
| Practice Location | |||||||||
| Address1: | 3817 NW EXPRESSWAY | ||||||||
| Address2: | STE 780 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731121489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057890541 | ||||||||
| FaxNumber: | 4057820541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 09/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | FOGLE | ||||||||
| AuthorizedOfficialFirstName: | RICH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9044936745 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 4107 | OK | Y | Agencies | Hospice Care, Community Based |
No ID Information.