Healthcare Provider Details

I. General information

NPI: 1114922598
Provider Name (Legal Business Name): CENTRAL OKLAHOMA UNITED METHODIST RETIREMENT FACILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 N PENNSYLVANIA AVE
OKLAHOMA CITY OK
73134
US

IV. Provider business mailing address

14901 N PENNSYLVANIA AVE
OKLAHOMA CITY OK
73134-6069
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-1200
  • Fax: 405-755-5106
Mailing address:
  • Phone: 405-752-1200
  • Fax: 405-755-5106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCC5504
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberCC5504
License Number StateOK

VIII. Authorized Official

Name: KENNETH LEE BULLOCK
Title or Position: CFO
Credential:
Phone: 405-749-3516