Provider Demographics
NPI:1225295710
Name:STATE OF OKLAHOMA
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:OKLAHOMA DEPARTMENT OF VETERANS AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERMIE
Authorized Official - Middle Name:CLINHNA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CLNC, LNHA
Authorized Official - Phone:405-523-4000
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-1209
Mailing Address - Country:US
Mailing Address - Phone:580-331-2200
Mailing Address - Fax:580-323-4834
Practice Address - Street 1:1701 SOUTH 4TH
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-1209
Practice Address - Country:US
Practice Address - Phone:580-331-2200
Practice Address - Fax:580-323-4834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA/ OK DEPT VETERANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKWVC2007003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility