Organization
IGNITE MEDICAL RESORT OKC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARET GLAZER (ATTORNEY)
(847) 324-7993
Entity
Organization
Contact information
Practice address
6312 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-1463
(405) 946-6932
Mailing address
1550 N NORTHWEST HWY STE 430, PARK RIDGE, IL 60068-1411
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
01/24/2020
Last updated
09/04/2020
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