1619978301 NPI number — SUNSET ESTATES OF PURCELL, INC

Table of content: (NPI 1619978301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619978301 NPI number — SUNSET ESTATES OF PURCELL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSET ESTATES OF PURCELL, INC
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:
1619978301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PURCELL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73080-0800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-527-2122
Provider Business Mailing Address Fax Number:
405-527-5706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 N 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PURCELL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73080-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-527-2122
Provider Business Practice Location Address Fax Number:
405-527-5706
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GANTZ
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
405-527-2122

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH4401-4401 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: NH4401-4401 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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