Healthcare Provider Details

I. General information

NPI: 1205931862
Provider Name (Legal Business Name): JENKS LIVING CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N 5TH ST
JENKS OK
74037-3343
US

IV. Provider business mailing address

711 N 5TH ST
JENKS OK
74037-3343
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-8508
  • Fax: 918-296-5612
Mailing address:
  • Phone: 918-299-8508
  • Fax: 918-296-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7202-7202
License Number StateOK

VIII. Authorized Official

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