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General NPI Number Information
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NPI Number | 1578605481
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Entity Type | Organization
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Legal Business Name | WILDWOOD MANAGEMENT COMPANY, L.L.C.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 3333 E 28TH ST
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City | TULSA
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State | OK
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Zip | 74114-5915
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Country | US
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Telephone | 918-747-8008
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Fax | 918-748-5970
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Provider Business Mailing Address
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Address Line | 1815 E SKELLY DR
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City | TULSA
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State | OK
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Zip | 74105-5919
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Country | US
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Telephone | 918-743-7838
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Fax | 918-748-5970
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Authorized Official
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Title or Position | MEMBER
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Name | MR. ED RUCKER
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Credential |
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Telephone | 918-743-7838
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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 | NH7209-7209
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License Number State | OK
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