Organization
ANGELIC FAMILY HOSPICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD HENRY KOLB RN, CRNI (OWNER / ADMINISTRATOR)
(405) 275-8300
Entity
Organization
Contact information
Practice address
421 N BEARD, SHAWNEE, OK 74801
(405) 275-8300
(405) 275-8300
Mailing address
421 N BEARD, SHAWNEE, OK 74801
(405) 275-8300
(405) 275-8300
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
4134
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000371591-001
BC&BS PROVIDER
OK
Enumeration date
10/04/2006
Last updated
11/02/2009
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