Provider Demographics
NPI:1164176442
Name:MERIDIAN LONG TERM CARE SERVICES LLC
Entity Type:Organization
Organization Name:MERIDIAN LONG TERM CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:469-387-0861
Mailing Address - Street 1:17393 S ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-9557
Mailing Address - Country:US
Mailing Address - Phone:469-387-0861
Mailing Address - Fax:
Practice Address - Street 1:17393 S ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9557
Practice Address - Country:US
Practice Address - Phone:469-387-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center