Healthcare Provider Details

I. General information

NPI: 1457620221
Provider Name (Legal Business Name): 202 HALEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 N GRAND ST
ENID OK
73701-1320
US

IV. Provider business mailing address

2911 N GRAND ST
ENID OK
73701-1320
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-3811
  • Fax:
Mailing address:
  • Phone: 580-242-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberRC2404
License Number StateOK

VIII. Authorized Official

Name: MRS. LISA MORRIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-242-3811