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General NPI Number Information
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NPI Number | 1376851402
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Entity Type | Organization
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Legal Business Name | BIXBY HEALTH AND REHABILITATION, LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 76 W RACHEL ST
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City | BIXBY
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State | OK
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Zip | 74008-4908
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Country | US
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Telephone | 918-366-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 S CENTRAL
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City | IDABEL
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State | OK
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Zip | 74745-7916
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Country | US
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Telephone | 580-286-2664
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. WILLIAM EDWARD DAVES
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Credential |
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Telephone | 580-286-2537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH7203-7203
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License Number State | OK
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