# LEISURE VILLAGE OPERATING LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Leisure Village Health Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760480768
- **Authorized official:** MS. DIANE H. HAMBRIC (VICE PRESIDENT)
- **Authorized official phone:** (918) 523-0222

## Contact information

- **Practice address:** 2154 S 85TH EAST AVE, TULSA, OK 74129-3012
- **Practice address phone:** (918) 622-4747
- **Practice address fax:** (918) 622-0304
- **Mailing address:** 4532 E 51ST ST STE H, TULSA, OK 74135-3705
- **Mailing address phone:** (918) 523-0222
- **Mailing address fax:** (918) 523-0224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH7216-7216 | OK | Yes |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 06/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200054790A | — | OK |