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General NPI Number Information
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NPI Number | 1528057312
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Entity Type | Organization
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Legal Business Name | S,L,W&J, INC.
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 112 S. MAGNOLIA AVE
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City | ERICK
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State | OK
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Zip | 73645
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Country | US
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Telephone | 580-526-3088
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Fax | 580-526-3747
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Provider Business Mailing Address
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Address Line | PO BOX 1223 112 S. MAGNOLIA
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City | ERICK
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State | OK
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Zip | 73645-1223
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Country | US
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Telephone | 580-526-3088
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Fax | 580-526-3747
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LEANN SMITH
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Credential |
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Telephone | 580-526-3088
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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 | NH0501-0501
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License Number State | OK
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