Healthcare Provider Details

I. General information

NPI: 1962637124
Provider Name (Legal Business Name): VIAN NURSING & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N THORNTON
VIAN OK
74962-0227
US

IV. Provider business mailing address

305 N THORNTON
VIAN OK
74962-0227
US

V. Phone/Fax

Practice location:
  • Phone: 918-773-5258
  • Fax: 918-773-5136
Mailing address:
  • Phone: 918-773-5258
  • Fax: 918-773-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH6804-6804
License Number StateOK

VIII. Authorized Official

Name: SCHUYLER W MONTGOMERY
Title or Position: MANAGING MEMBER
Credential:
Phone: 918-773-5258