# BEDLAM PROPERTIES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hillcrest Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053300269
- **Authorized official:** MR. MARK A LIETZKE (CEO - ISP)
- **Authorized official phone:** (918) 622-4799

## Contact information

- **Practice address:** 1210 S 6TH ST, BLACKWELL, OK 74631-4219
- **Practice address phone:** (580) 363-3244
- **Practice address fax:** (580) 363-2613
- **Mailing address:** 1805 E 15TH ST, TULSA, OK 74104-4610
- **Mailing address phone:** (918) 622-4799
- **Mailing address fax:** (918) 622-4798

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH36043604 | OK | Yes |

## Other

- **Enumeration date:** 10/19/2005
- **Last updated:** 08/26/2021