Healthcare Provider Details

I. General information

NPI: 1093082695
Provider Name (Legal Business Name): GBV ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2011
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E OWEN K GARRIOTT RD
ENID OK
73701-6151
US

IV. Provider business mailing address

1119 E OWEN K GARRIOTT RD
ENID OK
73701-6151
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-0121
  • Fax: 580-233-3755
Mailing address:
  • Phone: 580-233-0121
  • Fax: 580-233-3755

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: LORI LONG
Title or Position: CEO
Credential:
Phone: 580-233-0121