Healthcare Provider Details

I. General information

NPI: 1750124855
Provider Name (Legal Business Name): CHANDLER NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 1ST ST
CHANDLER OK
74834-2441
US

IV. Provider business mailing address

444991 EAST LOOP ROAD
GORE OK
74435
US

V. Phone/Fax

Practice location:
  • Phone: 405-258-1131
  • Fax:
Mailing address:
  • Phone: 479-236-9507
  • 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: TINA WHITLEY
Title or Position: COO
Credential:
Phone: 479-236-9507