Healthcare Provider Details

I. General information

NPI: 1003815796
Provider Name (Legal Business Name): N& R OF PONCA CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N WAVERLY ST
PONCA CITY OK
74601-2134
US

IV. Provider business mailing address

329 TOWNEPARK CIR SUITE 100
LOUISVILLE KY
40243-2348
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-6668
  • Fax: 580-762-2669
Mailing address:
  • Phone: 502-254-9525
  • Fax: 502-254-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH3606-3606
License Number StateOK

VIII. Authorized Official

Name: MR. JAY H TRUMBO
Title or Position: CFO
Credential:
Phone: 502-254-9525