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NPI Code Detail

MEDICARE: WINDSOR HILLS NURSING CENTER, LLC

MEDICARE: WINDSOR HILLS NURSING CENTER, 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
1314000000XSkilled Nursing FacilityNH 5516-5516OK

General Provider Information

NPI Number : 1376610972
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINDSOR HILLS NURSING CENTER, LLC
Provider Business Mailing Address
First Line : 2216 PAWNEE XING
Second Line :
City : EDMOND
State : OK
Zip : 73034-6835
Country : US
Telephone Number : 405-850-9005
Fax Number : 405-216-5528
Provider Business Practice Location Address
First Line : 2416 N ANN ARBOR AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73127-1811
Country : US
Telephone Number : 405-942-8566
Fax Number : 405-947-6848
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. RUSSEL WILSIE
Credential :
Telephone Number : 405-850-9005
Provider Enumeration Date : 11/29/2006
Last Update Date : 08/22/2020

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