Provider Demographics
NPI:1285835728
Name:ELEVEN PACK MANAGEMENT CORP.
Entity Type:Organization
Organization Name:ELEVEN PACK MANAGEMENT CORP.
Other - Org Name:BRIGHTON GARDENS OF OKLAHOMA CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-748-6464
Mailing Address - Street 1:12928 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-0817
Mailing Address - Country:US
Mailing Address - Phone:405-748-6464
Mailing Address - Fax:
Practice Address - Street 1:12928 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-0817
Practice Address - Country:US
Practice Address - Phone:405-748-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAL5513-5513310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility