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General NPI Number Information
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NPI Number | 1003815796
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Entity Type | Organization
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Legal Business Name | N& R OF PONCA CITY LLC
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1400 N WAVERLY ST
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City | PONCA CITY
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State | OK
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Zip | 74601-2134
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Country | US
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Telephone | 580-762-6668
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Fax | 580-762-2669
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Provider Business Mailing Address
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Address Line | 329 TOWNEPARK CIR SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40243-2348
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Country | US
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Telephone | 502-254-9525
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Fax | 502-254-9919
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Authorized Official
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Title or Position | CFO
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Name | MR. JAY H TRUMBO
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Credential |
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Telephone | 502-254-9525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH3606-3606
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License Number State | OK
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