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Organization
LEISURE VILLAGE OPERATING LLC
Active
Organization
LEISURE VILLAGE OPERATING LLC
Active
Other names
Leisure Village Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE H. HAMBRIC (VICE PRESIDENT)
(918) 523-0222
Entity
Organization
Contact information
Practice address
2154 S 85TH EAST AVE, TULSA, OK 74129-3012
(918) 622-4747
(918) 622-0304
Mailing address
4532 E 51ST ST STE H, TULSA, OK 74135-3705
(918) 523-0222
(918) 523-0224
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH7216-7216
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200054790A
—
OK
Enumeration date
07/13/2005
Last updated
06/14/2011
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