Provider Demographics
NPI:1467959866
Name:SANTA FE PLACE LLC
Entity Type:Organization
Organization Name:SANTA FE PLACE LLC
Other - Org Name:SANTA FE TUCSON HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-634-8888
Mailing Address - Street 1:1000 S SANTA FE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2469
Mailing Address - Country:US
Mailing Address - Phone:405-793-1643
Mailing Address - Fax:405-793-1675
Practice Address - Street 1:1000 S SANTA FE
Practice Address - Street 2:BUILDING C
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2469
Practice Address - Country:US
Practice Address - Phone:405-793-1643
Practice Address - Fax:405-793-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH1419315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities