Provider Demographics
NPI:1437320876
Name:DAVIS HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:DAVIS HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-994-4300
Mailing Address - Street 1:705 W QUEENS ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1767
Mailing Address - Country:US
Mailing Address - Phone:918-994-4300
Mailing Address - Fax:918-994-4301
Practice Address - Street 1:505 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-3136
Practice Address - Country:US
Practice Address - Phone:580-369-2653
Practice Address - Fax:580-369-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774540AMedicaid
OK375325Medicare PIN