Healthcare Provider Details

I. General information

NPI: 1790197747
Provider Name (Legal Business Name): ARBOR VILLAGE NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

102 E LINE AVE
SAPULPA OK
74066-2858
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-8166
  • Fax: 405-563-9447
Mailing address:
  • Phone: 918-224-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1902
License Number StateOK

VIII. Authorized Official

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