Healthcare Provider Details

I. General information

NPI: 1689029266
Provider Name (Legal Business Name): PF CRYSTAL PARK SNF OPS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 SW 80TH STREET
OKLAHOMA CITY OK
73139
US

IV. Provider business mailing address

1500 WATERS RIDGE DR STE 100
LEWISVILLE TX
75057-6056
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-4401
  • Fax:
Mailing address:
  • Phone: 214-725-2837
  • Fax: 469-312-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES M CHANCE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 214-725-2837