Organization
AUTUMN WOOD OPCO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA MERE (ASSOCIATE)
(325) 691-5591
Entity
Organization
Contact information
Practice address
2700 N HICKORY ST, CLAREMORE, OK 74017-1214
(918) 283-4949
(918) 283-4508
Mailing address
2700 N HICKORY ST, CLAREMORE, OK 74017-1214
(918) 283-4949
(918) 283-4508
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
NH6609
OK
314000000X
Skilled Nursing Facility
Primary
375553
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200478150A
—
OK
Enumeration date
09/11/2013
Last updated
07/21/2022
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