Provider Demographics
NPI:1467852244
Name:JLG HEALTHCARE LLC
Entity Type:Organization
Organization Name:JLG HEALTHCARE LLC
Other - Org Name:ELK CROSSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-658-2319
Mailing Address - Street 1:1603 TIMBERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1196
Mailing Address - Country:US
Mailing Address - Phone:580-658-2319
Mailing Address - Fax:
Practice Address - Street 1:811 W ELK
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1196
Practice Address - Country:US
Practice Address - Phone:580-658-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6902-6902313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375566Medicare Oscar/Certification