# SENIOR VILLAGE NURSING HOME

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

## Provider details

- **NPI number:** 1336132539
- **Authorized official:** MR. BOBBY VERNON SIMMONS D.PH (MANAGER)
- **Authorized official phone:** (405) 360-2562

## Contact information

- **Practice address:** 1104 N MADISON AVE, BLANCHARD, OK 73010-6504
- **Practice address phone:** (405) 485-3315
- **Mailing address:** 1104 N MADISON AVE, BLANCHARD, OK 73010-6504
- **Mailing address phone:** (405) 485-3315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH4403-4403 | OK | Yes |

## Other

- **Enumeration date:** 08/24/2005
- **Last updated:** 07/01/2008