Organization
ILA SEATON, LLC
Active
Other names
Willow Haven
Organization subpart
No
Provider details
NPI number
Authorized official
ILA M SEATON (MEMBER)
(918) 645-5905
Entity
Organization
Contact information
Practice address
1301 N 5TH ST, TONKAWA, OK 74653-1513
(580) 628-2529
(580) 628-9066
Mailing address
PO BOX 990, EDMOND, OK 73083-0990
(405) 285-8166
(405) 285-8177
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200255140A
—
OK
Enumeration date
08/27/2009
Last updated
09/17/2009
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