# WATERMARK CANTERBURY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Fountains at Canterbury
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740668847
- **Authorized official:** GRETA FRAZIER (DIRECTOR)
- **Authorized official phone:** (520) 797-4000

## Contact information

- **Practice address:** 1404 NW 122ND ST, OKLAHOMA CITY, OK 73114-8000
- **Practice address phone:** (405) 751-3600
- **Practice address fax:** (405) 751-6511
- **Mailing address:** 2020 W RUDASILL RD, TUCSON, AZ 85704-7800
- **Mailing address phone:** (520) 797-4000
- **Mailing address fax:** (520) 797-7757

## Taxonomy

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

## Other

- **Enumeration date:** 05/11/2015
- **Last updated:** 10/12/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CC5503-5503 | OKLAHOMA STATE DEPARTMENT OF HEALTH | OK |