Healthcare Provider Details

I. General information

NPI: 1902054059
Provider Name (Legal Business Name): BRYANT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E 9TH ST
EDMOND OK
73034-5705
US

IV. Provider business mailing address

1380 S DOUGLAS BLVD
MIDWEST CITY OK
73130-5215
US

V. Phone/Fax

Practice location:
  • Phone: 405-341-5617
  • Fax: 405-341-1792
Mailing address:
  • Phone: 405-737-2106
  • Fax: 405-737-0899

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: RAJ K. NARULA
Title or Position: DIRECT OWNER
Credential:
Phone: 405-737-2106