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NPI Code Detail

MEDICARE: PROMISE REDEEMER L L C

MEDICARE: PROMISE REDEEMER L L C
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
1314000000XSkilled Nursing FacilityNH5549OK

General Provider Information

NPI Number : 1679641542
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROMISE REDEEMER L L C
Provider Business Mailing Address
First Line : 1530 NE GRAND BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73117-5212
Country : US
Telephone Number : 405-424-2273
Fax Number :
Provider Business Practice Location Address
First Line : 1530 NE GRAND BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73117-5212
Country : US
Telephone Number : 405-424-2273
Fax Number :
Authorized Official
Title or Position : SOLE MEMBER
Name : STEPHEN C THOMPSON
Credential :
Telephone Number : 405-424-2273
Provider Enumeration Date : 12/01/2006
Last Update Date : 08/22/2020

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Directions to “PROMISE REDEEMER L L C ” Practice Location

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