Healthcare Provider Details

I. General information

NPI: 1346385689
Provider Name (Legal Business Name): LIGHTNING CREEK INVESTMENT GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SE 6TH ST
MOORELAND OK
73852-9064
US

IV. Provider business mailing address

PO BOX 468
NOWATA OK
74048-0468
US

V. Phone/Fax

Practice location:
  • Phone: 918-273-3649
  • Fax: 918-273-5652
Mailing address:
  • Phone: 918-273-3649
  • Fax: 918-273-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH7702-7702
License Number StateOK

VIII. Authorized Official

Name: MR. DOUGLAS G. MADDUX
Title or Position: PRESIDENT
Credential:
Phone: 918-273-3649