Healthcare Provider Details

I. General information

NPI: 1093016818
Provider Name (Legal Business Name): LTAC HOSPITAL OF EDMOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD FL 2
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

101 LA RUE FRANCE SUITE 500
LAFAYETTE LA
70508-3144
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-5822
  • Fax: 405-936-5559
Mailing address:
  • Phone: 337-269-9566
  • Fax: 337-234-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY W. HOWARD
Title or Position: PRESIDENT
Credential:
Phone: 337-269-9566