| NPI | 1801170139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY JACKSON President 918-629-9354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: OK RC7272-7272) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |