Provider Demographics
NPI:1447587670
Name:EL RENO RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:EL RENO RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:405-262-2440
Mailing Address - Street 1:2410 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2128
Mailing Address - Country:US
Mailing Address - Phone:405-262-2440
Mailing Address - Fax:405-262-0493
Practice Address - Street 1:2410 SUNSET DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2128
Practice Address - Country:US
Practice Address - Phone:405-262-2440
Practice Address - Fax:405-262-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility