# EASTGATE VILLAGE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083663512
- **Authorized official:** MRS. MARY LOUISE FLETCHER (ADMINISTRATOR)
- **Authorized official phone:** (918) 682-3191

## Contact information

- **Practice address:** 3500 HASKELL BLVD, MUSKOGEE, OK 74403-3915
- **Practice address phone:** (918) 682-3191
- **Practice address fax:** (918) 682-1131
- **Mailing address:** 3500 HASKELL BLVD, MUSKOGEE, OK 74403-3915
- **Mailing address phone:** (918) 682-3191
- **Mailing address fax:** (918) 682-1131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH5113-5113 | OK | — |
| 314000000X | Skilled Nursing Facility | NH5113-5113 | OK | Yes |

## Other

- **Enumeration date:** 05/10/2006
- **Last updated:** 09/11/2025