| NPI | 1114705340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA LUISKUTTY Administrator 918-955-9026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 314000000X Skilled Nursing Facility | |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |