Healthcare Provider Details

I. General information

NPI: 1740296490
Provider Name (Legal Business Name): PHOENIX HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 N COLUMBIA AVE
TULSA OK
74110-1232
US

IV. Provider business mailing address

3601 N COLUMBIA AVE
TULSA OK
74110-1232
US

V. Phone/Fax

Practice location:
  • Phone: 918-428-3600
  • Fax:
Mailing address:
  • Phone: 918-428-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7204
License Number StateOK

VIII. Authorized Official

Name: MS. CHRYSTAL WEST
Title or Position: BUSINESS OFFICE
Credential:
Phone: 918-743-3638