Healthcare Provider Details

I. General information

NPI: 1467790402
Provider Name (Legal Business Name): LANE NURSING & VENTILATOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N BROADWAY
INOLA OK
74036-9424
US

IV. Provider business mailing address

705 W. QUEENS ST.
BROKEN ARROW OK
74012-1767
US

V. Phone/Fax

Practice location:
  • Phone: 918-543-8800
  • Fax: 918-543-8801
Mailing address:
  • Phone: 918-994-4300
  • Fax: 918-994-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH6606-6606
License Number StateOK

VIII. Authorized Official

Name: MS. CASEY L DAVES
Title or Position: OWNER/OPERATOR
Credential: MS, SLP, LNHA
Phone: 918-994-4300