Organization
GRAND LAKE VILLA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELINE NADER (OWNER)
(918) 786-2276
Entity
Organization
Contact information
Practice address
103 W 13TH ST, GROVE, OK 74344-3224
(918) 786-2276
Mailing address
103 W 13TH ST, GROVE, OK 74344-3224
(918) 786-2276
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH 2102-2102
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200059540A
—
OK
Enumeration date
11/20/2006
Last updated
09/16/2011
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