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General NPI Number Information
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NPI Number | 1497944292
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Entity Type | Organization
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Legal Business Name | QUAIL RIDGE SENIOR DEVELOPMENT, LLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 12401 TRAIL OAKS DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-1701
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Country | US
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Telephone | 405-755-5775
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Fax | 405-749-9324
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Provider Business Mailing Address
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Address Line | 12401 TRAIL OAKS DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-1701
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Country | US
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Telephone | 405-755-5775
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Fax | 405-749-9324
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | MR. DAVID SMITH
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Credential |
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Telephone | 405-755-5775
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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 | AL5523-5523
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License Number State | OK
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