Organization
GGP, LLC
Active
Other names
GRAN GRAN'S PLACE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NELL LUSTY (ADMIN/OWNER)
(405) 350-2311
Entity
Organization
Contact information
Practice address
1110 S CORNWELL DR, YUKON, OK 73099-4632
(405) 350-2311
(405) 350-2379
Mailing address
1110 S CORNWELL DR, YUKON, OK 73099-4632
(405) 350-2311
(405) 350-2379
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH0905-0905
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100778340A
—
OK
Enumeration date
07/28/2005
Last updated
10/21/2020
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