Provider Demographics
NPI:1063630671
Name:BROKEN ARROW, LLC
Entity Type:Organization
Organization Name:BROKEN ARROW, LLC
Other - Org Name:CEDAR RIDGE AT BROKEN ARROW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-485-4600
Mailing Address - Street 1:3723 FAIRVIEW INDUSTRIAL DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1177
Mailing Address - Country:US
Mailing Address - Phone:503-485-4600
Mailing Address - Fax:
Practice Address - Street 1:10107 S GARNETT RD
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-1118
Practice Address - Country:US
Practice Address - Phone:918-461-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAL7256-7265310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility