Healthcare Provider Details

I. General information

NPI: 1811425606
Provider Name (Legal Business Name): OAKWOOD RETIREMENT VILLAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 N OAKWOOD RD
ENID OK
73703-9344
US

IV. Provider business mailing address

5801 N OAKWOOD RD
ENID OK
73703-9344
US

V. Phone/Fax

Practice location:
  • Phone: 580-249-2600
  • Fax:
Mailing address:
  • Phone: 580-249-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL2403-2403
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2408-2408
License Number StateOK

VIII. Authorized Official

Name: GARY LILLIE
Title or Position: MANAGER
Credential:
Phone: 580-249-2600