Healthcare Provider Details

I. General information

NPI: 1447253240
Provider Name (Legal Business Name): BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 MASHBURN BLVD
OKLAHOMA CITY OK
73162-5509
US

IV. Provider business mailing address

300 JOHNNY BENCH DR STE 400
OKLAHOMA CITY OK
73104-2470
US

V. Phone/Fax

Practice location:
  • Phone: 405-721-2466
  • Fax: 405-721-0668
Mailing address:
  • Phone: 405-724-2872
  • Fax: 405-721-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberCC55015501
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCC55015501
License Number StateOK

VIII. Authorized Official

Name: MR. WENDELL J SHORT
Title or Position: VP PLANNING & PROJECT MANAGEMENT
Credential:
Phone: 405-942-3000