Provider Demographics
NPI:1285632026
Name:WESTLAKE NURSING HOME LP
Entity Type:Organization
Organization Name:WESTLAKE NURSING HOME LP
Other - Org Name:QUAIL CREEK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-720-0010
Mailing Address - Street 1:13500 BRANDON PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4312
Mailing Address - Country:US
Mailing Address - Phone:405-720-0010
Mailing Address - Fax:
Practice Address - Street 1:13500 BRANDON PL
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4312
Practice Address - Country:US
Practice Address - Phone:405-720-0010
Practice Address - Fax:405-720-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5546-5546313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNH5546-5546Medicaid
OKNH5546-5546Medicaid