Healthcare Provider Details

I. General information

NPI: 1194716910
Provider Name (Legal Business Name): MONTEREAU INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 S GRANITE AVE
TULSA OK
74136-7039
US

IV. Provider business mailing address

6800 S GRANITE AVE
TULSA OK
74136-7039
US

V. Phone/Fax

Practice location:
  • Phone: 918-491-5222
  • Fax:
Mailing address:
  • Phone: 918-491-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCC7204-7204
License Number StateOK

VIII. Authorized Official

Name: MR. ROD WEAVER
Title or Position: DIRECTOR OF ACCOUNTING
Credential:
Phone: 918-491-5222