| NPI | 1376571711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN BRADFORD MONTGOMERY Owner 918-489-2755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: AR 804) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-08-22 |