Healthcare Provider Details

I. General information

NPI: 1376840892
Provider Name (Legal Business Name): LIVING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
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: 580-234-1520
Mailing address:
  • Phone: 580-234-1411
  • Fax: 580-234-1520

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: CHRIS BROGDON
Title or Position: MANAGER
Credential:
Phone: 770-650-8793