Healthcare Provider Details

I. General information

NPI: 1891700761
Provider Name (Legal Business Name): PHOENIX HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W BRITTON RD
OKLAHOMA CITY OK
73132-2402
US

IV. Provider business mailing address

5701 W BRITTON RD
OKLAHOMA CITY OK
73132-2402
US

V. Phone/Fax

Practice location:
  • Phone: 405-773-8900
  • Fax: 405-720-5825
Mailing address:
  • Phone: 405-773-8900
  • Fax: 405-720-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5519-5519
License Number StateOK

VIII. Authorized Official

Name: MRS. CHRYSTAL WEST
Title or Position: BUSINESS OFFICE
Credential:
Phone: 918-743-3638