MEDICARE: HARRISON WEST SENIOR LIVING, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1386432847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRISON WEST SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	1516 S BOSTON AVE STE 301
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74119-4019
Country	:	US
Telephone Number	:	918-592-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	579 W 5TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3174
Country	:	US
Telephone Number	:	380-208-1376
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	SHADOWOREE BETTS
Credential	:
Telephone Number	:	918-592-4400

Provider Enumeration Date	:	04/25/2025
Last Update Date	:	04/25/2025

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