Healthcare Provider Details

I. General information

NPI: 1992810410
Provider Name (Legal Business Name): ALTUS OPERATIONS L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 CEDAR CREEK DR
ALTUS OK
73521-1312
US

IV. Provider business mailing address

2610 CEDAR CREEK DR
ALTUS OK
73521-1312
US

V. Phone/Fax

Practice location:
  • Phone: 580-480-1800
  • Fax: 580-477-2006
Mailing address:
  • Phone: 580-480-1800
  • Fax: 580-477-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPENDING
License Number StateOK

VIII. Authorized Official

Name: MICHAEL DIMOND
Title or Position: MANAGER
Credential:
Phone: 405-943-1144