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General NPI Number Information
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NPI Number | 1740412998
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Entity Type | Organization
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Legal Business Name | PAULS VALLEY CARE CENTER LLC
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 1413 S CHICKASAW ST
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City | PAULS VALLEY
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State | OK
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Zip | 73075-6415
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Country | US
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Telephone | 405-238-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 S CHICKASAW ST
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City | PAULS VALLEY
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State | OK
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Zip | 73075-6415
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Country | US
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Telephone | 405-238-6411
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BART REED
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Credential |
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Telephone | 580-436-0950
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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 | NH2504-2504
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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 | NH2504-2504
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License Number State | OK
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