1780810119 NPI number — SIENNA EXTENDED CARE & REHAB LLC

Table of content: (NPI 1780810119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780810119 NPI number — SIENNA EXTENDED CARE & REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIENNA EXTENDED CARE & REHAB 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:
Provider Other Organization Name Type Code:
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:
1780810119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GORE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74435-0638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-489-2397
Provider Business Mailing Address Fax Number:
918-489-2371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9221 HARMONY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73130-6255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-489-2397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
SCHUYLER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING OWNER
Authorized Official Telephone Number:
918-489-2397

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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)





Copyright © 2007-2024 www.npivalidator.com