Healthcare Provider Details

I. General information

NPI: 1801470265
Provider Name (Legal Business Name): PARC PLACE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E MEMORIAL RD
OKLAHOMA CITY OK
73131-1240
US

IV. Provider business mailing address

PO BOX 990
EDMOND OK
73083-0990
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-8166
  • Fax:
Mailing address:
  • Phone: 405-285-8166
  • Fax: 405-563-9447

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: MR. SCOTT D. PILGRIM
Title or Position: MANAGING MEMBER
Credential:
Phone: 918-366-4492