Provider Demographics
NPI:1417302720
Name:CHANDLER THERAPY & LIVING CENTER LLC
Entity Type:Organization
Organization Name:CHANDLER THERAPY & LIVING CENTER LLC
Other - Org Name:CHANDLER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-258-1131
Mailing Address - Street 1:809 BAYONNE BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-0867
Mailing Address - Country:US
Mailing Address - Phone:405-258-1131
Mailing Address - Fax:
Practice Address - Street 1:601 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2441
Practice Address - Country:US
Practice Address - Phone:405-258-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375470Medicare Oscar/Certification