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General NPI Number Information
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NPI Number | 1114922598
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Entity Type | Organization
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Legal Business Name | CENTRAL OKLAHOMA UNITED METHODIST RETIREMENT FACILITY INC
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 14901 N PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134
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Country | US
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Telephone | 405-752-1200
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Fax | 405-755-5106
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Provider Business Mailing Address
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Address Line | 14901 N PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-6069
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Country | US
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Telephone | 405-752-1200
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Fax | 405-755-5106
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Authorized Official
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Title or Position | CFO
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Name | KENNETH LEE BULLOCK
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Credential |
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Telephone | 405-749-3516
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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 | CC5504
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | CC5504
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License Number State | OK
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