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General NPI Number Information
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NPI Number | 1033218326
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Entity Type | Organization
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Legal Business Name | BETTY ANN NURSING CENTER LLC
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 1400 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-5310
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Country | US
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Telephone | 918-786-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 S MAIN ST
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City | GROVE
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State | OK
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Zip | 74344-5310
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Country | US
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Telephone | 918-786-2275
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELINE NADER
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Credential |
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Telephone | 918-786-2275
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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 | NH 2101-2101
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License Number State | OK
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