Hospice Peachtree, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

4057 Issued in OK

Legal business name

HOSPICE PEACHTREE, LLC

Practice address

3100 N Broadway St
Poteau, OK 74953-5428

Phone

(918) 647-7008

Fax

(918) 647-7168

NPI assigned

Jul 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jim Petrus

Title

Chief Operating Officer

Phone

(479) 494-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Heart of Hospice LLC

  • Community Based Hospice Care Agency
  • Poteau, OK
  • NPI 1134609605

  Sold to, 2018-08-01

  CMS change of ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1184887572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 460",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749530460",
            "telephone_number": "918-647-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 N BROADWAY ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749535428",
            "telephone_number": "918-647-7008",
            "fax_number": "918-647-7168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE PEACHTREE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "PETRUS",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "479-494-0100"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OK",
            "license": "4057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100679750 B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hometown Drug Company LLC
• Hometown Drug Company LLC
• Hometown Drug Company LLC
• Doug E Horne, PHARMD
• Theresa Horton, PH.D.
• Hospital Care Consultants of Poteau LLC
• Laura House, M.ED
• Huddleston Health LLC
• Krystel Huddleston, DNP, APRN, FNP-C
• Donna Sue Huggins

• Community Based Hospice Care Agency in Poteau, OK
• Providers in Poteau, OK by specialty
• Community Based Hospice Care Agency in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.