37D0858863 CLIA NUMBER - HOSPICE OF NORTH CENTRAL OKLAHOMA

Laboratory Demographics

CLIA Number: 37D0858863

Facility Name: HOSPICE OF NORTH CENTRAL OKLAHOMA

Facility Address:
445 FAIRVIEW AVE
PONCA CITY, OK
ZIP 74601
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Facility Phone Number: 580 762-9102

Facility Type: Hospice

Certificate Type: Waiver

NPI Number: 1043201890

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	37D0858863
LAB Type	Hospice
Facility Name	HOSPICE OF NORTH CENTRAL OKLAHOMA
Street	445 FAIRVIEW AVE
City	PONCA CITY
State	OK
ZIP	74601
Phone	580 762-9102
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024