Organization
WOODLAND PARK HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED RUCKER (PRESIDENT)
(918) 743-7838
Entity
Organization
Contact information
Practice address
5707 S MEMORIAL DR, TULSA, OK 74145-9004
(918) 252-2521
Mailing address
5707 S MEMORIAL DR, TULSA, OK 74145-9004
(918) 252-2521
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
NH 7232-7232
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200114440A
—
OK
Enumeration date
05/03/2007
Last updated
05/20/2011
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