# IGNITE MEDICAL RESORT OKC, LLC

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

## Provider details

- **NPI number:** 1316577679
- **Authorized official:** JARET GLAZER (ATTORNEY)
- **Authorized official phone:** (847) 324-7993

## Contact information

- **Practice address:** 6312 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-1463
- **Practice address phone:** (405) 946-6932
- **Mailing address:** 1550 N NORTHWEST HWY STE 430, PARK RIDGE, IL 60068-1411

## Taxonomy

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

## Other

- **Enumeration date:** 01/24/2020
- **Last updated:** 09/04/2020