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General NPI Number Information
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NPI Number | 1396291365
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Entity Type | Organization
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Legal Business Name | 24TH PLACE LLC
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 600 24TH AVE SW
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City | NORMAN
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State | OK
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Zip | 73069-3913
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Country | US
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Telephone | 405-747-6154
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Fax |
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Provider Business Mailing Address
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Address Line | 131 N BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5003
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Country | US
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Telephone | 580-436-0950
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Fax | 580-436-0953
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Authorized Official
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Title or Position | MANAGER
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Name | BART REED
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Credential |
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Telephone | 580-399-7920
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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 | NH1409-1409
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License Number State | OK
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