Provider Demographics
NPI:1043643042
Name:APEX REHABILITATION OKC LLC
Entity type:Organization
Organization Name:APEX REHABILITATION OKC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DAVIN
Authorized Official - Last Name:ANDRADA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:405-655-2939
Mailing Address - Street 1:3120 W BRITTON RD STE 205
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2038
Mailing Address - Country:US
Mailing Address - Phone:405-655-2939
Mailing Address - Fax:
Practice Address - Street 1:3120 W BRITTON RD STE 205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2038
Practice Address - Country:US
Practice Address - Phone:405-655-2939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK707261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)