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General NPI Number Information
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NPI Number | 1164422416
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Entity Type | Organization
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Legal Business Name | PARKLAND MANOR LIVING CENTER LLC
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 200 W PARKLAND NBU 7407
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City | PRAGUE
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State | OK
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Zip | 74864
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Country | US
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Telephone | 405-567-2201
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Fax | 405-567-2395
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Provider Business Mailing Address
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Address Line | 200 W PARKLAND
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City | PRAGUE
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State | OK
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Zip | 74864
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Country | US
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Telephone | 405-567-2201
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Fax | 405-567-2395
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MISS JULIE JUSTICE
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Credential |
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Telephone | 405-447-3911
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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 | NH4103
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License Number State | OK
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