Provider Demographics
NPI:1043209992
Name:RANCH TERRACE NURSING HOME, INC.
Entity Type:Organization
Organization Name:RANCH TERRACE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-224-2578
Mailing Address - Street 1:1310 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4829
Mailing Address - Country:US
Mailing Address - Phone:918-224-2578
Mailing Address - Fax:918-227-2907
Practice Address - Street 1:1310 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4829
Practice Address - Country:US
Practice Address - Phone:918-224-2578
Practice Address - Fax:918-227-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH1905-1905313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility