Healthcare Provider Details

I. General information

NPI: 1740353689
Provider Name (Legal Business Name): ST.JOHN VILLAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17110 E 51ST ST
BROKEN ARROW OK
74012-9279
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-1596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberCC7202-7202
License Number StateOK

VIII. Authorized Official

Name: MR. LEX ANDERSON
Title or Position: TREASURER, ST. JOHN VILLAS INC
Credential:
Phone: 918-744-3072