Provider Demographics
NPI:1437212198
Name:MG MILLER-MANAGEMENT & HOLDING LTD CO
Entity Type:Organization
Organization Name:MG MILLER-MANAGEMENT & HOLDING LTD CO
Other - Org Name:GOLDEN OAKS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-249-2600
Mailing Address - Street 1:5801 N OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-9344
Mailing Address - Country:US
Mailing Address - Phone:580-249-2600
Mailing Address - Fax:580-233-3426
Practice Address - Street 1:5801 N OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-9344
Practice Address - Country:US
Practice Address - Phone:580-249-2600
Practice Address - Fax:580-233-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-17
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH 2408-2408313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100777560AMedicaid
OK375406Medicare Oscar/Certification