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General NPI Number Information
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NPI Number | 1578272969
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Entity Type | Organization
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Legal Business Name | BONNY CREST CHOICE LIVING LLC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 700 W FORT WORTH ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-3719
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Country | US
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Telephone | 918-949-4555
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Fax | 918-933-5352
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Provider Business Mailing Address
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Address Line | 700 W FORT WORTH ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-3719
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Country | US
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Telephone | 918-949-4555
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Fax | 918-933-5352
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Authorized Official
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Title or Position | DIRECTOR/ADMINISTRATOR
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Name | MR. CHRIS JUMBO
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Credential |
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Telephone | 918-949-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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