NPIMap

Organization Active NPI

Suncrest Hospice Tulsa LLC

  • Community Based Hospice Care Agency
  • Tulsa, OK
National Provider Identifier
1629645247
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SUNCREST HOSPICE TULSA LLC
Practice address
4555 S Harvard Ave Ste C
Tulsa, OK 74135-2915
Phone
(918) 221-6366
Fax
(918) 922-7470
NPI assigned
Jun 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Authorized official

Name
Christopher Harris
Title
Ceo
Phone
(801) 849-0486

Specialties & licenses 1

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

Addresses

Primary practice location

4555 S Harvard Ave Ste C
Tulsa, OK 74135-2915

Mailing address

9800 S Monroe St Ste 900
Sandy, UT 84070-4419
Phone (801) 849-0486

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211215001811 OK Part A Provider - Hospice 4880085414 Practice locations: Tulsa, OK

Hospice certification: CCN 371729

Legal name
SUNCREST HOSPICE TULSA LLC
Doing business as
SUNCREST HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 17, 2022
Last certification
Feb 17, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Jun 9, 2021 in UT
Enrollment address
4555 S Harvard Ave
Ste C
Tulsa, OK 74135-2915

Care Compare: Hospice

Medicare Care Compare
Listed as
Suncrest HospiceCCN 371729
Ownership
For-Profit
Certified
Feb 17, 2022
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2233913Suncrest Hospice Tulsa, LLC4555 S Harvard Ave, Ste C, Tulsa, OK 74135Certificate of waiverAug 25, 2027

National Provider Directory

National Provider Directory

Locations

4555 S Harvard Ave
Ste C
Tulsa, OK 74135
Phone (918) 221-6366

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Terry C Hermance Individual Contracted Managing EmployeeMD; Jan 1, 2024 100%
Scott David Perucca Individual 5% Or Greater Indirect Ownership InterestCso Jan 3, 2024 34.2%
Corporate OfficerCso Jun 9, 2021 47%
Christopher Jay Harris Individual 5% Or Greater Indirect Ownership Interest Jan 3, 2024 5%
Corporate OfficerCeo Jan 3, 2022
Erin M Bennett Individual 5% Or Greater Indirect Ownership Interest Jan 3, 2024 13.3%
Tyler M Godfrey Individual 5% Or Greater Indirect Ownership InterestCfo Jan 3, 2024 34.2%
Corporate OfficerCfo Jun 9, 2021 47%
Thomas B Godfrey Individual 5% Or Greater Indirect Ownership Interest Jan 3, 2024 13.3%
Suncrest Health Services LLC Organization, Sandy, UT LLC 5% Or Greater Direct Ownership Interest Jun 9, 2021 100%
Kristie Downs Individual W-2 Managing EmployeeAd; Jan 1, 2024 100%
Sarah Eileen Nielsen Individual W-2 Managing Employee Jan 3, 2024
G&B Newco Inc Organization, Sandy, UT Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 3, 2024 26.6%
Anne Nisley Individual W-2 Managing EmployeeAdministrator Jun 9, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 40

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

View all 40

Practitioners & affiliated clinicians

Affiliated clinicians 9

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": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1629645247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 S MONROE ST STE 900",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840704419",
            "telephone_number": "801-849-0486",
            "fax_number": "801-849-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 S HARVARD AVE STE C",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352915",
            "telephone_number": "918-221-6366",
            "fax_number": "918-922-7470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCREST HOSPICE TULSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-849-0486"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.