Healthcare Provider Details

I. General information

NPI: 1538156625
Provider Name (Legal Business Name): SALINA CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N OWEN WALTERS BLVD
SALINA OK
74365-4403
US

IV. Provider business mailing address

1505 W CHICKASAW AVE
SALLISAW OK
74955-7201
US

V. Phone/Fax

Practice location:
  • Phone: 918-434-5600
  • Fax: 918-434-5226
Mailing address:
  • Phone: 918-775-6200
  • Fax: 918-775-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000X
License Number StateOK

VIII. Authorized Official

Name: MS. SANDRA TAYLOR
Title or Position: VP IN CHARGE OF REIMBURSEMENT
Credential:
Phone: 918-775-6200