- Enrollment id
- O20161028001665
- Enrollment state
- OK
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1639286032
- Multiple npi flag
- N
- Ccn
- 371643
- Associate id
- 2062790835
- Organization name
- CARTER HEALTHCARE HOSPICE OF NORTH OKLAHOMA, LLC
- Incorporation date
- 2015-12-01
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 210 E GRAHAM AVE
- City
- PRYOR
- State
- OK
- Zip code
- 743612437