Provider Demographics
NPI:1386631398
Name:MEDI-PLEX NURSING CENTERS, INC.
Entity Type:Organization
Organization Name:MEDI-PLEX NURSING CENTERS, INC.
Other - Org Name:WILLOW HAVEN NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP IN CHARGE OF REIMBURSEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-775-6200
Mailing Address - Street 1:1301 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-1513
Mailing Address - Country:US
Mailing Address - Phone:580-628-2529
Mailing Address - Fax:580-628-3517
Practice Address - Street 1:1301 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-1513
Practice Address - Country:US
Practice Address - Phone:580-628-2529
Practice Address - Fax:580-628-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK313M00000X313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility