Provider Demographics
NPI:1073571956
Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC
Entity Type:Organization
Organization Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC
Other - Org Name:ENTRUSTED HEARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PLANNING & PROJECT MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-3000
Mailing Address - Street 1:3800 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6639
Mailing Address - Country:US
Mailing Address - Phone:405-942-3000
Mailing Address - Fax:405-942-0018
Practice Address - Street 1:7410 N 127TH EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4010
Practice Address - Country:US
Practice Address - Phone:918-272-4694
Practice Address - Fax:918-272-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7295251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100810750FMedicaid
OK1073571956OtherNPI
OK100810750FMedicaid