# D E K MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NORTHSIDE NURSING HOME
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629001409
- **Authorized official:** MR. ERNEST M JOHNSON III (ADMINISTRATOR/MANAGING MEMBER)
- **Authorized official phone:** (918) 224-0833

## Contact information

- **Practice address:** 102 E LINE AVE, SAPULPA, OK 74066-2858
- **Practice address phone:** (918) 224-0833
- **Practice address fax:** (918) 227-2405
- **Mailing address:** 10842 S 137TH WEST AVE, SAPULPA, OK 74066-6737
- **Mailing address phone:** (918) 224-0833
- **Mailing address fax:** (918) 227-2405

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH1902-1902 | OK | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 11/15/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200044850A | — | OK |