Healthcare Provider Details

I. General information

NPI: 1477533487
Provider Name (Legal Business Name): PF SOUTH YUKON SNF OPS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S YUKON PKWY
YUKON OK
73099-4584
US

IV. Provider business mailing address

1500 WATERS RIDGE DR
LEWISVILLE TX
75057-6011
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-2022
  • Fax: 405-354-8461
Mailing address:
  • Phone: 972-899-4401
  • Fax: 972-899-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5604-5604
License Number StateOK

VIII. Authorized Official

Name: JAMES M CHANCE
Title or Position: AUTHORIZED OFFICER
Credential:
Phone: 214-725-2837