Healthcare Provider Details

I. General information

NPI: 1487654786
Provider Name (Legal Business Name): GREENBRIER NURSING HOME NUMBER TWO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E GARRIOTT RD
ENID OK
73701-6151
US

IV. Provider business mailing address

1119 E GARRIOTT RD
ENID OK
73701-6151
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-0121
  • Fax: 580-233-3755
Mailing address:
  • Phone: 580-223-0121
  • Fax: 580-233-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2404-2404
License Number StateOK

VIII. Authorized Official

Name: JIM THORPE
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-233-0121