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NPI Code Detail

MEDICARE: EL RENO NURSING CENTER LLC

MEDICARE: EL RENO NURSING CENTER LLC
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 FacilityNH0903-0903OK

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 : 1770688319
Entity Type Code : Organization
Provider Name (Legal Business Name) : EL RENO NURSING CENTER LLC
Provider Business Mailing Address
First Line : 1901 PARKVIEW DR
Second Line :
City : EL RENO
State : OK
Zip : 73036-2105
Country : US
Telephone Number : 405-262-2833
Fax Number : 405-262-2878
Provider Business Practice Location Address
First Line : 1901 PARKVIEW DR
Second Line :
City : EL RENO
State : OK
Zip : 73036-2105
Country : US
Telephone Number : 405-262-2833
Fax Number : 405-262-2878
Authorized Official
Title or Position : DIRECTOR OF REIMBURSEMENT
Name : KRISTY DEROIN
Credential :
Telephone Number : 405-943-1144
Provider Enumeration Date : 09/14/2006
Last Update Date : 02/05/2026

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Directions to “EL RENO NURSING CENTER LLC ” Practice Location

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