Healthcare Provider Details

I. General information

NPI: 1508041302
Provider Name (Legal Business Name): ODVA NORMAN DIVISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 E ROBINSON ST
NORMAN OK
73071-7442
US

IV. Provider business mailing address

1776 E ROBINSON ST
NORMAN OK
73071-7442
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-5600
  • Fax: 405-364-8432
Mailing address:
  • Phone: 405-360-5600
  • Fax: 405-364-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberWVC2007-0004
License Number StateOK

VIII. Authorized Official

Name: ROBERT WEEKS
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-360-5600