Healthcare Provider Details

I. General information

NPI: 1891787925
Provider Name (Legal Business Name): WOODLAWN L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 S CHICKASAW ST
PAULS VALLEY OK
73075-6415
US

IV. Provider business mailing address

PO BOX 250
PAULS VALLEY OK
73075-0250
US

V. Phone/Fax

Practice location:
  • Phone: 405-238-6411
  • Fax: 405-238-9278
Mailing address:
  • Phone: 405-238-6411
  • Fax: 405-238-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH2504
License Number StateOK

VIII. Authorized Official

Name: ELLA MAE WINKLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-238-6411