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General NPI Number Information
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NPI Number | 1508103763
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Entity Type | Organization
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Legal Business Name | NW 61ST NURSING, LLC
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 2801 NW 61ST ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7007
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Country | US
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Telephone | 405-842-6601
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Fax | 405-810-8482
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Provider Business Mailing Address
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Address Line | 2801 NW 61ST ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-7007
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Country | US
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Telephone | 405-842-6601
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Fax | 405-810-8482
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BOYD P GENTRY
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Credential |
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Telephone | 678-869-5116
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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 | NH5524-5524
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License Number State | OK
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