Organization
EASTGATE VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LOUISE FLETCHER (ADMINISTRATOR)
(918) 682-3191
Entity
Organization
Contact information
Practice address
3500 HASKELL BLVD, MUSKOGEE, OK 74403-3915
(918) 682-3191
(918) 682-1131
Mailing address
3500 HASKELL BLVD, MUSKOGEE, OK 74403-3915
(918) 682-3191
(918) 682-1131
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
NH5113-5113
OK
314000000X
Skilled Nursing Facility
Primary
NH5113-5113
OK
Other
Enumeration date
05/10/2006
Last updated
09/11/2025
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