Healthcare Provider Details

I. General information

NPI: 1376610972
Provider Name (Legal Business Name): WINDSOR HILLS NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 N ANN ARBOR AVE
OKLAHOMA CITY OK
73127-1811
US

IV. Provider business mailing address

2216 PAWNEE XING
EDMOND OK
73034-6835
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-8566
  • Fax: 405-947-6848
Mailing address:
  • Phone: 405-850-9005
  • Fax: 405-216-5528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH 5516-5516
License Number StateOK

VIII. Authorized Official

Name: MR. RUSSEL WILSIE
Title or Position: MANAGING MEMBER
Credential:
Phone: 405-850-9005