Organization
WALNUT GROVE LIVING CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PEGGY W. BENNETT (ADMINISTRATOR)
(918) 423-7373
Entity
Organization
Contact information
Practice address
1001 S GEORGE NIGH EXPY, MCALESTER, OK 74501-7286
(918) 423-7373
(918) 423-7156
Mailing address
PO BOX 3303, MCALESTER, OK 74502-3303
(918) 423-7373
(918) 423-7156
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH6110-6110
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100776710A
—
OK
Enumeration date
07/07/2005
Last updated
04/02/2012
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