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General NPI Number Information
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NPI Number | 1659894202
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Entity Type | Organization
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Legal Business Name | 76TH STREET LAND LLC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 7707 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74133-3643
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Country | US
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Telephone | 918-394-1803
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Fax |
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Provider Business Mailing Address
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Address Line | 6271 E 120TH CT STE 100
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City | TULSA
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State | OK
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Zip | 74137-8813
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Country | US
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Telephone | 918-394-1803
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Fax |
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Authorized Official
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Title or Position | OWNER / AUTHORIZED OFFICIAL
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Name | STEVEN COX
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Credential |
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Telephone | 918-232-0305
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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 | NH7234
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH7234
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License Number State | OK
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