Provider Demographics
NPI:1407923824
Name:WARR ACRES NURSING CENTER, LLC
Entity Type:Organization
Organization Name:WARR ACRES NURSING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-850-9005
Mailing Address - Street 1:2216 PAWNEE XING
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6835
Mailing Address - Country:US
Mailing Address - Phone:405-850-9005
Mailing Address - Fax:405-216-5528
Practice Address - Street 1:6501 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-6505
Practice Address - Country:US
Practice Address - Phone:405-721-5444
Practice Address - Fax:405-722-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH 5515-5515314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
37-5275Medicare ID - Type Unspecified