Healthcare Provider Details

I. General information

NPI: 1356869341
Provider Name (Legal Business Name): CITY OF SAPULPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W CANADIAN AVE
VINITA OK
74301-2702
US

IV. Provider business mailing address

PO BOX 990
EDMOND OK
73083-0990
US

V. Phone/Fax

Practice location:
  • Phone: 918-256-8768
  • Fax: 918-256-8760
Mailing address:
  • Phone: 405-285-8166
  • Fax: 405-563-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH1802
License Number StateOK

VIII. Authorized Official

Name: BILL BUSH
Title or Position: CFO
Credential:
Phone: 405-285-8166