Healthcare Provider Details

I. General information

NPI: 1881101459
Provider Name (Legal Business Name): COMMUNITY NURSING CENTER OF OKLAHOMA CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N SHARTEL AVE STE 300
OKLAHOMA CITY OK
73103-2425
US

IV. Provider business mailing address

1211 N SHARTEL AVE STE 300
OKLAHOMA CITY OK
73103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-0026
  • Fax:
Mailing address:
  • Phone: 405-848-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL ROOMS
Title or Position: PRACTITIONER
Credential: ARNP
Phone: 405-388-2258