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General NPI Number Information
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NPI Number | 1447358965
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Entity Type | Organization
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Legal Business Name | OSAGE NURSING CENTER, LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 822 W OSAGE AVE
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City | NOWATA
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State | OK
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Zip | 74048-3317
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Country | US
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Telephone | 918-273-2012
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Fax | 918-273-3631
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | SALLISAW
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State | OK
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Zip | 74955-0429
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Country | US
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Telephone | 918-775-4439
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Fax | 918-775-9242
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JUSTIN MCGREW
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Credential |
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Telephone | 918-775-4439
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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 | NH5303-5303
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License Number State | OK
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