# OK4 FT. GIBSON OPCO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Fort Gibson Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215382734
- **Authorized official:** ISAAC DOLE (MANAGER/PRINCIPAL)
- **Authorized official phone:** (773) 645-9246

## Contact information

- **Practice address:** 205 E POPLAR ST, FORT GIBSON, OK 74434-8272
- **Practice address phone:** (918) 478-2456
- **Mailing address:** 2045 W GRAND AVE STE B-34572, CHICAGO, IL 60612-1576
- **Mailing address phone:** (773) 645-9246

## Taxonomy

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

## Other

- **Enumeration date:** 05/03/2016
- **Last updated:** 10/29/2024