Healthcare Provider Details

I. General information

NPI: 1619334919
Provider Name (Legal Business Name): BELL AVENUE NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 BELL AVE
ELK CITY OK
73644-2254
US

IV. Provider business mailing address

2301 BELL AVE
ELK CITY OK
73644-2254
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-3335
  • Fax:
Mailing address:
  • Phone: 580-225-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0505
License Number StateOK

VIII. Authorized Official

Name: BILL BUSH
Title or Position: CFO
Credential:
Phone: 405-285-8166