Provider Demographics
NPI:1376851402
Name:BIXBY HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:BIXBY HEALTH AND REHABILITATION, LLC
Other - Org Name:SOUTHTOWN NURSING AND VENTILATOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-2537
Mailing Address - Street 1:2310 S CENTRAL
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7916
Mailing Address - Country:US
Mailing Address - Phone:580-286-2664
Mailing Address - Fax:
Practice Address - Street 1:76 W RACHEL ST
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-4908
Practice Address - Country:US
Practice Address - Phone:918-366-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7203-7203313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility