# WASHITA VALLEY LIVING CENTER, INC

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

## Provider details

- **NPI number:** 1528075546
- **Authorized official:** MR. JACK JUSTICE (OWNER)
- **Authorized official phone:** (405) 238-5528

## Contact information

- **Practice address:** 105 WASHINGTON ST, PAULS VALLEY, OK 73075-5039
- **Practice address phone:** (405) 238-5528
- **Practice address fax:** (405) 238-7989
- **Mailing address:** 105 WASHINGTON ST, PAULS VALLEY, OK 73075-5039
- **Mailing address phone:** (405) 238-5528
- **Mailing address fax:** (405) 238-7989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH25012501 | OK | Yes |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 07/16/2007