Healthcare Provider Details

I. General information

NPI: 1841288727
Provider Name (Legal Business Name): PARKS EDGE CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 W HOUSTON ST
BROKEN ARROW OK
74012-3734
US

IV. Provider business mailing address

415 ROGERS AVE
FORT SMITH AR
72901-1903
US

V. Phone/Fax

Practice location:
  • Phone: 539-367-4500
  • Fax: 539-367-4510
Mailing address:
  • Phone: 479-783-4672
  • Fax: 479-783-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7219-7219
License Number StateOK

VIII. Authorized Official

Name: MR. MICHAEL S. MORTON
Title or Position: PRESIDENT
Credential:
Phone: 479-783-4672