Organization
SENIOR VILLAGE NURSING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOBBY VERNON SIMMONS D.PH (MANAGER)
(405) 360-2562
Entity
Organization
Contact information
Practice address
1104 N MADISON AVE, BLANCHARD, OK 73010-6504
(405) 485-3315
Mailing address
1104 N MADISON AVE, BLANCHARD, OK 73010-6504
(405) 485-3315
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH4403-4403
OK
Other
Enumeration date
08/24/2005
Last updated
07/01/2008
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