Healthcare Provider Details

I. General information

NPI: 1134177223
Provider Name (Legal Business Name): BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 N 127TH EAST AVE
OWASSO OK
74055-4010
US

IV. Provider business mailing address

300 JOHNNY BENCH DR STE 400
OKLAHOMA CITY OK
73104-2470
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-4694
  • Fax: 918-272-2267
Mailing address:
  • Phone: 405-724-2872
  • Fax: 405-942-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7796
License Number StateOK

VIII. Authorized Official

Name: WENDELL SHORT
Title or Position: VP PLANNING & PROJECT MANAGEMENT
Credential:
Phone: 405-942-3000