Healthcare Provider Details

I. General information

NPI: 1609860568
Provider Name (Legal Business Name): EQUITY FUNDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E MAIN ST
HEALDTON OK
73438-1839
US

IV. Provider business mailing address

406 E MAIN ST
HEALDTON OK
73438-1839
US

V. Phone/Fax

Practice location:
  • Phone: 580-229-0737
  • Fax: 580-229-0128
Mailing address:
  • Phone: 580-229-0737
  • Fax: 580-229-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1004-1004
License Number StateOK

VIII. Authorized Official

Name: SHARON KAYE BAILEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-229-0737