Active NPI
Legacy Family Hospice, LLC
- Community Based Hospice Care Agency
- Oklahoma City, OK
National Provider Identifier
1689313728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- LEGACY FAMILY HOSPICE, LLC
- Practice address
- 13104 N Macarthur Blvd Ste a
Oklahoma City, OK 73142-3017 - Phone
- (405) 832-0150
- Fax
- (405) 832-0250
- NPI assigned
- May 27, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Holly Pankhurst
- Title
- Administrator
- Phone
- (405) 832-0150
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
13104 N Macarthur Blvd Ste a
Oklahoma City, OK 73142-3017
Mailing address
13104 N Macarthur Blvd Ste a
Oklahoma City, OK 73142-3017
Phone (405) 832-0150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230120002672 | OK | Part A Provider - Hospice | 8820469273 | Practice locations: Oklahoma City, OK; Weatherford, OK |
Hospice certification: CCN 371735
- Legal name
- LEGACY FAMILY HOSPICE, LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 25, 2023
- Last certification
- Feb 9, 2023
- Organization structure
- LLC
- Incorporated
- Apr 24, 2022 in OK
- Enrollment address
- 13104 N Macarthur Blvd
Ste a
Oklahoma City, OK 73142-3017
Care Compare: Hospice
Medicare Care Compare- Listed as
- Legacy Family Hospice, LLC
- Certified
- Feb 25, 2023
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2286503 | Legacy Family Hospice, LLC | Certificate of waiver | Jul 30, 2027 |
National Provider Directory
National Provider DirectoryLocations
3030 NW Expressway
Ste 875
Oklahoma City, OK 73112
13104 N MacArthur Blvd
Ste A
Oklahoma City, OK 73142
Phone (405) 832-0150
701 E Main St
Ste E
Weatherford, OK 73096
Phone (405) 832-0150
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Holly Pankhurst | Contracted Managing Employee | May 22, 2022 | 25% |
| 5% Or Greater Direct Ownership Interest | Apr 24, 2022 | 37.5% | |
| Mark G Miles | Contracted Managing Employee | Nov 8, 2024 | |
| Christine Hamilton | Contracted Managing Employee | May 22, 2022 | |
| 5% Or Greater Direct Ownership Interest | Apr 24, 2022 | 37.5% | |
| Adam V Stephens | Contracted Managing Employee | May 7, 2023 | |
| Gary Basey | 5% Or Greater Direct Ownership Interest | Apr 24, 2022 | 25% |
| Leslie Hendricks | W-2 Managing Employee | Apr 1, 2025 |
Owners & managing parties with NPI records 2
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Hospitalist Physician
- Oklahoma City, OK
- NPI 1255335287
Contracted Managing Employee
-
- Family Medicine Physician
- Oklahoma City, OK
- NPI 1528018942
Contracted Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 11
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": "1653609600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1717027200000",
"number": "1689313728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13104 N MACARTHUR BLVD STE A",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731423017",
"telephone_number": "405-832-0150",
"fax_number": "405-832-0250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13104 N MACARTHUR BLVD STE A",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731423017",
"telephone_number": "405-832-0150",
"fax_number": "405-832-0250"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEGACY FAMILY HOSPICE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-05-27",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"status": "A",
"authorized_official_last_name": "PANKHURST",
"authorized_official_first_name": "HOLLY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "405-832-0150"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.