Carter Healthcare Hospice of Northeast Oklahoma, LLC
Organization Active NPI Community Based Hospice Care Agency · Bixby, OK
NPI 1295842664 · NPPES record last updated Jul 16, 2025
Key facts
- NPI
- 1295842664
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 4042 (OK)
- Legal business name
- CARTER HEALTHCARE HOSPICE OF NORTHEAST OKLAHOMA, LLC
- Practice address
- 6630 E 121St St
Suite 108
Bixby, OK 74008 - Phone
- (918) 425-4000
- Fax
- (918) 428-0780
- NPI assigned
- Aug 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Justin Carter
- Title
- Authorized Official/President
- Phone
- (405) 947-7700
Owners & managing parties with NPI records 1
Affiliated clinicians 1
Medicare Care Compare: Hospice
- Listed as
- Carter Healthcare Hospice of Northeast Oklahoma LLC
- Ownership
- For-Profit
- Certified
- Nov 9, 1999
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Hospice certification: CCN 371580
- Legal name
- CARTER HEALTHCARE HOSPICE OF NORTHEAST OKLAHOMA LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 9, 1999
- Last certification
- Jun 3, 2021
- Ownership / control type
- Proprietary - Individual
- Organization structure
- LLC · Proprietary
- Enrollment address
- 6630 E 121St St
Suite 108
Bixby, OK 74008
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Joseph M Moore |
W-2 Managing Employee |
Dec 11, 2023 | 10% |
| Cynthia Carter |
5% Or Greater Indirect Ownership Interest |
Sep 27, 2022 | 9.71% |
| W-2 Managing Employee |
Sep 27, 2022 | 9.71% | |
| Shannon Clark-Leigh |
W-2 Managing Employee |
Aug 21, 2023 | 90% |
| Justin Carter |
5% Or Greater Indirect Ownership Interest |
Feb 7, 2023 | 90.29% |
| Corporate Officer |
Sep 27, 2022 | 90.29% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Nov 1, 2016 | Change of Ownership |
Carter Healthcare & Hospice |
| Nov 1, 2016 | Change of Ownership |
Carter Healthcare Hospice of Northeast Oklahoma LLC |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160929001936 | OK | Part a Provider - Hospice | 2860789104 | Practice locations: Bixby, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 4042 | OK | Yes |
Addresses
Primary practice location
6630 E 121St St
Suite 108
Bixby, OK 74008
Mailing address
7725 W Reno Ave Ste 332
Oklahoma City, OK 73127-9799
Phone (405) 947-7700
Other providers in Bixby, OK
- Casey Marie Cale
- Careatc - Bixby
- Katie Cariker
- Kaylor Carlton
- Carter Healthcare DME of Northeast Oklahoma LLC
- Carter Healthcare of Northeast Oklahoma, LLC
- Ethan Graham Chandler
- Ashtyn Skylar Cherrington
- David Noel Chorley
- Christopher Trockel Orthodontics PC
All providers in Bixby, OK · Community Based Hospice Care Agency in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.