Provider Demographics
NPI:1447521562
Name:EDMOND HEALTH AND REHABILITATION, LLC
Entity type:Organization
Organization Name:EDMOND HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-994-4300
Mailing Address - Street 1:705 W QUEENS ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1767
Mailing Address - Country:US
Mailing Address - Phone:918-994-4300
Mailing Address - Fax:918-994-4301
Practice Address - Street 1:1100 E 9TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5705
Practice Address - Country:US
Practice Address - Phone:228-327-5477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility