MEDICARE: NORTH WINDS LIVING CENTER INC

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	NH5528-5528	OK

General Provider Information

NPI Number	:	1932144003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH WINDS LIVING CENTER INC

Provider Business Mailing Address
First Line	:	3714 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2924
Country	:	US
Telephone Number	:	405-942-3884
Fax Number	:	405-946-2642

Provider Business Practice Location Address
First Line	:	3718 N PORTLAND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2924
Country	:	US
Telephone Number	:	405-942-1014
Fax Number	:	405-943-4933

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JUDY M CRANE
Credential	:
Telephone Number	:	405-942-3884

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/22/2020

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