# SOUTHWEST LTC LAWTON LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Park Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588055206
- **Authorized official:** RONALD R PAYNE (CEO)
- **Authorized official phone:** (469) 916-6100

## Contact information

- **Practice address:** 7019 NW CACHE RD, LAWTON, OK 73505-2707
- **Practice address phone:** (469) 916-6100
- **Practice address fax:** (469) 916-6105
- **Mailing address:** 1518 LEGACY DR, SUITE 110, FRISCO, TX 75034-6038
- **Mailing address phone:** (469) 916-6100
- **Mailing address fax:** (469) 916-6105

## Taxonomy

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

## Other

- **Enumeration date:** 02/17/2015
- **Last updated:** 02/17/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200102040A | — | OK |