Healthcare Provider Details

I. General information

NPI: 1396291365
Provider Name (Legal Business Name): 24TH PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 24TH AVE SW
NORMAN OK
73069-3913
US

IV. Provider business mailing address

131 N BROADWAY AVE
ADA OK
74820-5003
US

V. Phone/Fax

Practice location:
  • Phone: 405-747-6154
  • Fax:
Mailing address:
  • Phone: 580-436-0950
  • Fax: 580-436-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1409-1409
License Number StateOK

VIII. Authorized Official

Name: BART REED
Title or Position: MANAGER
Credential:
Phone: 580-399-7920