Healthcare Provider Details

I. General information

NPI: 1831332824
Provider Name (Legal Business Name): LEGEND AT COUNCIL ROAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11320 N COUNCIL RD
OKLAHOMA CITY OK
73162-2517
US

IV. Provider business mailing address

11320 N COUNCIL RD
OKLAHOMA CITY OK
73162-2517
US

V. Phone/Fax

Practice location:
  • Phone: 405-721-0300
  • Fax:
Mailing address:
  • Phone: 405-721-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITA BURKHALTER
Title or Position: RESIDENCE DIRECTOR
Credential:
Phone: 405-721-0300