1790473502 NPI number — COMMUNITY NURSING CENTER OF OKLAHOMA CITY, LLC

Table of content: (NPI 1790473502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790473502 NPI number — COMMUNITY NURSING CENTER OF OKLAHOMA CITY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY NURSING CENTER OF OKLAHOMA CITY, 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:
DIVERSITY FAMILY HEALTH
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:
1790473502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 N SHARTEL AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73103-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-848-0026
Provider Business Mailing Address Fax Number:
405-497-6789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 WHITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73069-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-848-0026
Provider Business Practice Location Address Fax Number:
405-497-6789
Provider Enumeration Date:
04/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HOLT
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
RCM MANAGER
Authorized Official Telephone Number:
405-407-7661

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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