Shepherd's Care Hospice of Wagoner, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

4177 Issued in OK

Legal business name

SHEPHERD'S CARE HOSPICE OF WAGONER, LLC

Practice address

611 W Cherokee St
Wagoner, OK 74467-4618

Phone

(918) 485-4673

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Deena K. Bottom, RN, MS ,CHN

Title

President

Phone

(918) 485-4673

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912960089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674618",
            "telephone_number": "918-485-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674618",
            "telephone_number": "918-485-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEPHERD'S CARE HOSPICE OF WAGONER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOTTOM",
        "authorized_official_first_name": "DEENA",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-485-4673",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, MS ,CHN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OK",
            "license": "4177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jimmy Todd Self, LPC
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• Jace Evan Sharp, DPT
• Pamela Louise Sharp
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• Valerie Sherman
• Zona Marie Siler
• Marissa Sinclair
• Melissa Slape, MSW U/S
• Tarek Sleem

• Community Based Hospice Care Agency in Wagoner, OK
• Providers in Wagoner, OK by specialty
• Community Based Hospice Care Agency in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.