Autumnbridge Southwest LLC
Organization Active NPI Community Based Hospice Care Agency · Tulsa, OK
NPI 1821079161 · NPPES record last updated Oct 13, 2015
Key facts
- NPI
- 1821079161
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 4196 (OK)
- Legal business name
- AUTUMNBRIDGE SOUTHWEST LLC
- Practice address
- 2642 E 21St St
Tulsa, OK 74114-1716 - Phone
- (918) 236-4866
- Fax
- (918) 236-4867
- NPI assigned
- Nov 11, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. William Lowery Slaughter
- Title
- Controller
- Phone
- (405) 613-0055
Change of ownership 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Apr 1, 2019 | Change of Ownership |
Amedisys Hospice |
National Provider Directory
Locations
1608 W Jones Ave
Duncan, OK 73533
Phone (580) 252-1266
2642 E 21st St
Tulsa, OK 74114
Phone (918) 236-4866
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 4196 | OK | Yes |
Addresses
Primary practice location
2642 E 21St St
Tulsa, OK 74114-1716
Mailing address
2642 E 21St St
Tulsa, OK 74114-1716
Phone (918) 236-4866
Other names
- RoseRock Healthcare
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All providers in Tulsa, 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 Oct 13, 2015. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.