Organization
SHADY REST CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA TAYLOR (VP IN CHARGE OF REIMBURSEMENT)
(918) 775-6200
Entity
Organization
Contact information
Practice address
210 S ADAIR ST, PRYOR, OK 74361-5202
(918) 825-4455
(918) 825-8493
Mailing address
1505 W CHICKASAW AVE, SALLISAW, OK 74955-7201
(918) 775-6200
(918) 775-5643
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
314000000X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100777350A
—
OK
Enumeration date
10/04/2005
Last updated
02/26/2009
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