MEDICARE: SAVANAH BROOK PARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	65769	OK

General Provider Information

NPI Number	:	1114317435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANAH BROOK PARKS

Provider Business Mailing Address
First Line	:	12001 SW 31ST ST
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-3691
Country	:	US
Telephone Number	:	405-492-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 ASTORIA WAY
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-5997
Country	:	US
Telephone Number	:	405-676-8470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2015
Last Update Date	:	01/15/2026

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Directions to “ SAVANAH BROOK PARKS ” Practice Location

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