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General NPI Number Information
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NPI Number | 1417947805
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Entity Type | Organization
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Legal Business Name | UNIVERSITY VILLAGE HEALTHCARE, LLC
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 8555 S LEWIS AVE
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City | TULSA
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State | OK
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Zip | 74137-1218
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Country | US
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Telephone | 918-298-3321
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Fax | 918-298-3691
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Provider Business Mailing Address
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Address Line | 8555 S LEWIS AVE
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City | TULSA
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State | OK
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Zip | 74137-1218
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Country | US
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Telephone | 918-298-3321
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Fax | 918-298-3691
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Authorized Official
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Title or Position | COO
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Name | MS. VANESSA ILENE NEAL
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Credential | NHA
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Telephone | 918-298-3652
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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 | NH7231
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License Number State | OK
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