Provider Demographics
NPI:1396838439
Name:SENIOR CITIZENS NURSING CENTER, INC.
Entity Type:Organization
Organization Name:SENIOR CITIZENS NURSING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-251-3200
Mailing Address - Street 1:1306 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4205
Mailing Address - Country:US
Mailing Address - Phone:918-251-3200
Mailing Address - Fax:918-251-9865
Practice Address - Street 1:1306 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4205
Practice Address - Country:US
Practice Address - Phone:918-251-3200
Practice Address - Fax:918-251-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH 7224-7224313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKN-=========Medicaid
OK375233Medicare ID - Type Unspecified