Healthcare Provider Details

I. General information

NPI: 1891891768
Provider Name (Legal Business Name): PRETTY WATER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15223 W 81ST ST S
SAPULPA OK
74066-2984
US

IV. Provider business mailing address

15223 W 81ST ST S
SAPULPA OK
74066-2984
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-4952
  • Fax: 918-224-4039
Mailing address:
  • Phone: 918-224-4952
  • Fax: 918-224-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR0042052
License Number StateOK

VIII. Authorized Official

Name: MS. LUCILE M. HENDRICKS
Title or Position: R.N.
Credential: R.N.
Phone: 918-224-4952