Basic Information
| Provider Information | |||||||||
| NPI: | 1831215219 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEARTLAND HOSPICE-BROKEN BOW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004271902 | ||||||||
| FaxNumber: | 4192545336 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 S PARK DR | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | BROKEN BOW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747285331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805847687 | ||||||||
| FaxNumber: | 5805847697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOTSON | ||||||||
| AuthorizedOfficialFirstName: | DOVIRN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTS RECEIVABLE SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 8004271902 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.