Healthcare Provider Details

I. General information

NPI: 1518685536
Provider Name (Legal Business Name): HEARTSWORTH OPERATIONS SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W CANADIAN AVE
VINITA OK
74301-2702
US

IV. Provider business mailing address

1200 W CANADIAN AVE
VINITA OK
74301-2702
US

V. Phone/Fax

Practice location:
  • Phone: 918-256-8768
  • Fax: 918-770-0215
Mailing address:
  • Phone: 918-256-8768
  • Fax: 918-770-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID GANZ
Title or Position: MANAGER
Credential:
Phone: 832-422-8848