Healthcare Provider Details

I. General information

NPI: 1447358965
Provider Name (Legal Business Name): OSAGE NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W OSAGE AVE
NOWATA OK
74048-3317
US

IV. Provider business mailing address

PO BOX 429
SALLISAW OK
74955-0429
US

V. Phone/Fax

Practice location:
  • Phone: 918-273-2012
  • Fax: 918-273-3631
Mailing address:
  • Phone: 918-775-4439
  • Fax: 918-775-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH5303-5303
License Number StateOK

VIII. Authorized Official

Name: MR. JUSTIN MCGREW
Title or Position: MEMBER
Credential:
Phone: 918-775-4439