Organization
D E K MANAGEMENT LLC
Active
Other names
NORTHSIDE NURSING HOME
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERNEST M JOHNSON III (ADMINISTRATOR/MANAGING MEMBER)
(918) 224-0833
Entity
Organization
Contact information
Practice address
102 E LINE AVE, SAPULPA, OK 74066-2858
(918) 224-0833
(918) 227-2405
Mailing address
10842 S 137TH WEST AVE, SAPULPA, OK 74066-6737
(918) 224-0833
(918) 227-2405
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH1902-1902
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200044850A
—
OK
Enumeration date
07/07/2006
Last updated
11/15/2012
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