Provider Demographics
NPI:1033218326
Name:BETTY ANN NURSING CENTER LLC
Entity Type:Organization
Organization Name:BETTY ANN NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-786-2275
Mailing Address - Street 1:1400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-5310
Mailing Address - Country:US
Mailing Address - Phone:918-786-2275
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-5310
Practice Address - Country:US
Practice Address - Phone:918-786-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH 2101-2101314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200053270AMedicaid
OK200053270AMedicaid