Organization
WASHITA VALLEY LIVING CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK JUSTICE (OWNER)
(405) 238-5528
Entity
Organization
Contact information
Practice address
105 WASHINGTON ST, PAULS VALLEY, OK 73075-5039
(405) 238-5528
(405) 238-7989
Mailing address
105 WASHINGTON ST, PAULS VALLEY, OK 73075-5039
(405) 238-5528
(405) 238-7989
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH25012501
OK
Other
Enumeration date
08/02/2006
Last updated
07/16/2007
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