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General NPI Number Information
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NPI Number | 1902946346
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Entity Type | Organization
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Legal Business Name | BLEVINS RETIREMENT & CARE CENTER L L C
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 1220 E ELECTRIC AVE
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City | MCALESTER
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State | OK
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Zip | 74501-3832
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Country | US
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Telephone | 918-423-9095
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Fax | 918-423-1317
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Provider Business Mailing Address
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Address Line | 1220 E ELECTRIC AVE
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City | MCALESTER
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State | OK
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Zip | 74501-3832
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Country | US
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Telephone | 918-423-9095
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Fax | 918-423-1317
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Authorized Official
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Title or Position | MEMBER
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Name | JUSTIN PRICE
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Credential |
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Telephone | 918-967-9285
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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 | 100778160A
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License Number State | OK
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