Provider Demographics
NPI:1447253240
Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA INC
Entity type:Organization
Organization Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PLANNING & PROJECT MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-3000
Mailing Address - Street 1:9700 MASHBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-5509
Mailing Address - Country:US
Mailing Address - Phone:405-721-2466
Mailing Address - Fax:405-721-0668
Practice Address - Street 1:9700 MASHBURN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-5509
Practice Address - Country:US
Practice Address - Phone:405-721-2466
Practice Address - Fax:405-721-0668
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCC55015501313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774330AMedicaid
OK375381Medicare ID - Type Unspecified