Healthcare Provider Details

I. General information

NPI: 1033218326
Provider Name (Legal Business Name): BETTY ANN NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S MAIN ST
GROVE OK
74344-5310
US

IV. Provider business mailing address

1400 S MAIN ST
GROVE OK
74344-5310
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-2275
  • Fax:
Mailing address:
  • Phone: 918-786-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH 2101-2101
License Number StateOK

VIII. Authorized Official

Name: MICHELINE NADER
Title or Position: OWNER
Credential:
Phone: 918-786-2275