Healthcare Provider Details

I. General information

NPI: 1780921155
Provider Name (Legal Business Name): SEMINOLE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2013
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E WRANGLER BLVD
SEMINOLE OK
74868-3512
US

IV. Provider business mailing address

1200 E WRANGLER BLVD
SEMINOLE OK
74868-3512
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-1127
  • Fax: 405-382-1129
Mailing address:
  • Phone: 405-382-1127
  • Fax: 405-382-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUDAH BIENSTOCK
Title or Position: MANAGING MEMBER
Credential:
Phone: 314-812-2550