MEDICARE: RELIANT LIVING CENTERS OF OKLAHOMA

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	313M00000X	Nursing Facility/Intermediate Care Facility	NH5537	OK

General Provider Information

NPI Number	:	1780720045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIANT LIVING CENTERS OF OKLAHOMA

Provider Business Mailing Address
First Line	:	2901 SE 22ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-8413
Country	:	US
Telephone Number	:	405-677-2421
Fax Number	:	405-677-4276

Provider Business Practice Location Address
First Line	:	2901 SE 22ND ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-8413
Country	:	US
Telephone Number	:	405-677-2421
Fax Number	:	405-677-4276

Authorized Official
Title or Position	:	ADMINSTRATROR
Name	:	MS. JANELLE F JERNIGNA
Credential	:	ADMINISTRATOR
Telephone Number	:	405-677-0502

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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