Healthcare Provider Details

I. General information

NPI: 1174993265
Provider Name (Legal Business Name): GLENPOOL OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 141ST ST
GLENPOOL OK
74033-3807
US

IV. Provider business mailing address

1700 E 141ST ST
GLENPOOL OK
74033-3807
US

V. Phone/Fax

Practice location:
  • Phone: 918-291-4230
  • Fax: 918-291-2429
Mailing address:
  • Phone: 918-291-4230
  • Fax: 918-291-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7233-7233
License Number StateOK

VIII. Authorized Official

Name: MIKE DIMOND
Title or Position: MANAGER
Credential:
Phone: 405-943-1144