MEDICARE: HARRAH WHITES MEADOWS NURSING, LLC

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	314000000X	Skilled Nursing Facility	NH5551-5551	OK

General Provider Information

NPI Number	:	1336571132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRAH WHITES MEADOWS NURSING, LLC

Provider Business Mailing Address
First Line	:	2400 WHITES MEADOW DR
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9402
Country	:	US
Telephone Number	:	405-454-6255
Fax Number	:	405-454-6257

Provider Business Practice Location Address
First Line	:	2400 WHITES MEADOW DR
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9402
Country	:	US
Telephone Number	:	405-454-6255
Fax Number	:	405-454-6257

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	BOYD P GENTRY
Credential	:
Telephone Number	:	678-869-5116

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	01/19/2022

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