Healthcare Provider Details

I. General information

NPI: 1568554657
Provider Name (Legal Business Name): BROOKHAVEN GARDENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RAMBLING OAKS DR
NORMAN OK
73072-4195
US

IV. Provider business mailing address

1050 RAMBLING OAKS DR
NORMAN OK
73072-4195
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-2273
  • Fax: 405-292-4040
Mailing address:
  • Phone: 405-292-2273
  • Fax: 405-292-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH14051405
License Number StateOK

VIII. Authorized Official

Name: DR. DIRK P O'HARA
Title or Position: MANAGING MEMBER
Credential:
Phone: 405-292-2273