Healthcare Provider Details

I. General information

NPI: 1528163383
Provider Name (Legal Business Name): WOODWARD NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E DOWNS AVE
WOODWARD OK
73801-6107
US

IV. Provider business mailing address

429 E DOWNS AVE
WOODWARD OK
73801-6107
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-6448
  • Fax: 580-256-5180
Mailing address:
  • Phone: 580-256-6448
  • Fax: 580-256-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7003-7703
License Number StateOK

VIII. Authorized Official

Name: MIKE DIMOND
Title or Position: MANAGER
Credential:
Phone: 405-943-1144