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NPI Code Detail

MEDICARE: VIA CHRISTI VILLAGE PONCA CITY INC

MEDICARE: VIA CHRISTI VILLAGE PONCA CITY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility
2314000000XSkilled Nursing Facility100775130AOK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215150297
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIA CHRISTI VILLAGE PONCA CITY INC
Provider Business Mailing Address
First Line : 1601 ACADEMY RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-4409
Country : US
Telephone Number : 580-762-0927
Fax Number : 580-762-0933
Provider Business Practice Location Address
First Line : 1601 ACADEMY RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-4409
Country : US
Telephone Number : 580-762-0927
Fax Number : 580-762-0933
Authorized Official
Title or Position : CEO
Name : ERIN SHADBOLT
Credential :
Telephone Number : 314-729-3500
Provider Enumeration Date : 04/10/2007
Last Update Date : 06/23/2025

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Directions to “VIA CHRISTI VILLAGE PONCA CITY INC ” Practice Location

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