Organization
OK4 FT. GIBSON OPCO LLC
Active
Other names
Fort Gibson Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
ISAAC DOLE (MANAGER/PRINCIPAL)
(773) 645-9246
Entity
Organization
Contact information
Practice address
205 E POPLAR ST, FORT GIBSON, OK 74434-8272
(918) 478-2456
Mailing address
2045 W GRAND AVE STE B-34572, CHICAGO, IL 60612-1576
(773) 645-9246
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
OK
Other
Enumeration date
05/03/2016
Last updated
10/29/2024
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