1164422416 NPI number — PARKLAND MANOR LIVING CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164422416 NPI number — PARKLAND MANOR LIVING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKLAND MANOR LIVING CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARKLAND MANOR LIVING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164422416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W PARKLAND
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAGUE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74864
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-567-2201
Provider Business Mailing Address Fax Number:
405-567-2395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W PARKLAND NBU 7407
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAGUE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-567-2201
Provider Business Practice Location Address Fax Number:
405-567-2395
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JUSTICE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
405-447-3911

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH4103 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100770310A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com