Organization
LEGEND AT JEFFERSON'S GARDEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NELDA RANDALL (DIRECTOR)
(405) 715-1717
Entity
Organization
Contact information
Practice address
15401 N PENNSYLVANIA AVE, EDMOND, OK 73013
(405) 715-1717
(405) 715-9017
Mailing address
15401 N PENNSYLVANIA AVE, EDMOND, OK 73013
(405) 715-1717
(405) 715-9017
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
AL5517-5517
OK
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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