Healthcare Provider Details

I. General information

NPI: 1558071621
Provider Name (Legal Business Name): VILLAGE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 01/20/2023
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 S MAIN ST
BROKEN ARROW OK
74012-6502
US

IV. Provider business mailing address

PO BOX 668
GORE OK
74435-0668
US

V. Phone/Fax

Practice location:
  • Phone: 918-251-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. COLTON MONTGOMERY
Title or Position: OWNER
Credential:
Phone: 918-251-2626