| NPI | 1063968352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS LUISKUTTY Manager 918-640-4425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| 310400000X Assisted Living Facility | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |