Healthcare Provider Details

I. General information

NPI: 1669411575
Provider Name (Legal Business Name): PSG WESTERN HILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5396 NW CACHE RD
LAWTON OK
73505-3313
US

IV. Provider business mailing address

5396 NW CACHE RD
LAWTON OK
73505-3313
US

V. Phone/Fax

Practice location:
  • Phone: 580-342-6228
  • Fax: 580-342-5015
Mailing address:
  • Phone: 580-342-6228
  • Fax: 580-342-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LUCRETIA LEE PARKEY
Title or Position: EXCUTIVE DIRECTOR
Credential:
Phone: 580-342-6228