Healthcare Provider Details

I. General information

NPI: 1376075051
Provider Name (Legal Business Name): SERVANT LIVING CENTER - BEGGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N CHIPPEWA
BEGGS OK
74421-2053
US

IV. Provider business mailing address

3325 FRENCH PARK DR SUITE 6
EDMOND OK
73034-7277
US

V. Phone/Fax

Practice location:
  • Phone: 918-267-3362
  • Fax: 405-563-9447
Mailing address:
  • Phone: 405-285-8166
  • Fax: 405-563-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberNH5619
License Number StateOK

VIII. Authorized Official

Name: SCOTT PILGRIM
Title or Position: MEMBER
Credential:
Phone: 405-285-8166