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General NPI Number Information
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NPI Number | 1285835728
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Entity Type | Organization
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Legal Business Name | ELEVEN PACK MANAGEMENT CORP.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12928 N MAY AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-0817
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Country | US
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Telephone | 405-748-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 12928 N MAY AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-0817
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Country | US
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Telephone | 405-748-6464
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DONNA KILGORE
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Credential |
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Telephone | 405-748-6464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL5513-5513
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License Number State | OK
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