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General NPI Number Information
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NPI Number | 1275106163
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Entity Type | Organization
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Legal Business Name | DURANT FOUR SEASONS OPERATING CO., LLC
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 1212 FOUR SEASONS DR
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City | DURANT
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State | OK
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Zip | 74701-2430
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Country | US
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Telephone | 580-677-9911
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Fax | 580-634-4756
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Provider Business Mailing Address
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Address Line | 1908 12TH AVE NW STE E
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City | ARDMORE
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State | OK
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Zip | 73401-1255
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Country | US
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Telephone | 580-226-3055
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TOM C. COBLE
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Credential |
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Telephone | 580-220-7093
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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 |
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License Number State |
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