MEDICARE: PHOENIX HEALTHCARE 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	NH5519-5519	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891700761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	5701 W BRITTON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-2402
Country	:	US
Telephone Number	:	405-773-8900
Fax Number	:	405-720-5825

Provider Business Practice Location Address
First Line	:	5701 W BRITTON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-2402
Country	:	US
Telephone Number	:	405-773-8900
Fax Number	:	405-720-5825

Authorized Official
Title or Position	:	BUSINESS OFFICE
Name	:	MRS. CHRYSTAL WEST
Credential	:
Telephone Number	:	918-743-3638

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/08/2008

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