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General NPI Number Information
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NPI Number | 1891700761
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Entity Type | Organization
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Legal Business Name | PHOENIX HEALTHCARE LLC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 5701 W BRITTON RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-2402
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Country | US
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Telephone | 405-773-8900
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Fax | 405-720-5825
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Provider Business Mailing Address
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Address Line | 5701 W BRITTON RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-2402
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Country | US
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Telephone | 405-773-8900
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Fax | 405-720-5825
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Authorized Official
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Title or Position | BUSINESS OFFICE
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Name | MRS. CHRYSTAL WEST
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Credential |
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Telephone | 918-743-3638
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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 | NH5519-5519
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License Number State | OK
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