Organization
LEISURE VILLAGE OPERATING LLC
Active
Other names
Leisure Village Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE H. HAMBRIC (VICE PRESIDENT)
(918) 523-0222
Entity
Organization
Contact information
Practice address
2154 S 85TH EAST AVE, TULSA, OK 74129-3012
(918) 622-4747
(918) 622-0304
Mailing address
4532 E 51ST ST STE H, TULSA, OK 74135-3705
(918) 523-0222
(918) 523-0224
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH7216-7216
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200054790A
—
OK
Enumeration date
07/13/2005
Last updated
06/14/2011
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