Healthcare Provider Details

I. General information

NPI: 1174697379
Provider Name (Legal Business Name): THE LIVING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 N 17TH ST
ENID OK
73701-2685
US

IV. Provider business mailing address

1409 N 17TH ST
ENID OK
73701-2685
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-1411
  • Fax:
Mailing address:
  • Phone: 580-234-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH 2401-2401
License Number StateOK

VIII. Authorized Official

Name: MICHELINE NADER
Title or Position: OWNWR
Credential:
Phone: 918-786-2276