Provider Demographics
NPI:1578452405
Name:GOOD SHEPHERD HOSPICE OF COLUMBIA LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD HOSPICE OF COLUMBIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DELESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-0903
Mailing Address - Street 1:4350 WILL ROGERS PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1840
Mailing Address - Country:US
Mailing Address - Phone:405-702-0803
Mailing Address - Fax:855-586-7591
Practice Address - Street 1:3301 W BROADWAY BUSINESS PARK CT STE G
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0106
Practice Address - Country:US
Practice Address - Phone:405-702-0803
Practice Address - Fax:855-586-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based