Healthcare Provider Details

I. General information

NPI: 1003898784
Provider Name (Legal Business Name): INVERNESS VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 71ST ST
TULSA OK
74132-2150
US

IV. Provider business mailing address

3800 W 71ST ST
TULSA OK
74132-2150
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-9988
  • Fax: 918-481-9989
Mailing address:
  • Phone: 918-481-9988
  • Fax: 918-481-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCC1902-1902
License Number StateOK

VIII. Authorized Official

Name: MR. TERRY THOMPKINS
Title or Position: EXECUTIVE DIRECTOR
Credential: E.D
Phone: 918-388-4706