NPIMap

Organization Active NPI

Lifecare Hospice, LLC

  • Community Based Hospice Care Agency
  • Edmond, OK
National Provider Identifier
1366143802
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LIFECARE HOSPICE, LLC
Practice address
1900 E 15TH St Ste 500C
Edmond, OK 73013-6696
Phone
(844) 329-4545
Fax
(405) 310-3371
NPI assigned
Mar 13, 2023
Last updated
Mar 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Authorized official

Name
Mrs. Karen Elaine Vahlberg
Title
Governing Body
Phone
(405) 203-2715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

1900 E 15TH St Ste 500C
Edmond, OK 73013-6696

Mailing address

2411 Springer Dr
Norman, OK 73069-3955
Phone (405) 329-4545

Other names 1

  • LifeCare Hospice Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250224001181 OK Part A Provider - Hospice 9931629789 Practice locations: Edmond, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366143802. Details of each certification follow.

Hospice certification: CCN 371744

Legal name
LIFECARE HOSPICE LLC
Doing business as
DEACONESS HEALTHCARE HOLDINGS, INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 25, 2024
Last certification
Jun 5, 2024
Organization structure
LLCProprietary
Enrollment address
1900 E 15TH St
Ste 500C
Edmond, OK 73013-6696

Care Compare: Hospice

Medicare Care Compare
Listed as
Lifecare Hospice, LLCCCN 371744 · All quality measures
Certified
Jun 25, 2024
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1900 E 15th St
Ste 500C
Edmond, OK 73013
Phone (405) 329-4545

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Healther Gfeller Individual 5% Or Greater Indirect Ownership Interest Mar 7, 2023 8%
Matt Stuart Individual 5% Or Greater Indirect Ownership Interest Mar 7, 2023 8%
Haley Botello Individual 5% Or Greater Indirect Ownership Interest Mar 7, 2023 4%
The Deaconess Associates, Inc. Organization, Cincinnati, OH Corporation 5% Or Greater Indirect Ownership Interest Mar 7, 2023 80%
Karen E Vahlberg Individual Corporate OfficerManager Mar 7, 2023
W-2 Managing EmployeeCeo Mar 7, 2023
Deaconess Healthcare Holdings, Inc. Organization, Cincinnati, OH Holding company 5% Or Greater Direct Ownership Interest Mar 7, 2023 80%
3Rd Gen Hospice LLC Organization, Edmond, OK LLC 5% Or Greater Direct Ownership Interest Mar 7, 2023 20%
Amber E Newkirk Individual W-2 Managing EmployeeAd; Mar 7, 2023
Lifespring Home Care and Hospice, LLC Organization, Norman, OK Holding company 5% Or Greater Direct Ownership Interest Mar 7, 2023 80%
Operational/Managerial Control Mar 7, 2023 80%

Facilities with the same owner 37

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 37

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1366143802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 SPRINGER DR",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730693955",
            "telephone_number": "405-329-4545",
            "fax_number": "405-310-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 E 15TH ST STE 500C",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730136696",
            "telephone_number": "844-329-4545",
            "fax_number": "405-310-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "VAHLBERG",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "GOVERNING BODY",
        "authorized_official_telephone_number": "405-203-2715",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeCare Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.