Provider Demographics
NPI:1497760268
Name:VIAN NURSING HOME, INC
Entity Type:Organization
Organization Name:VIAN NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-773-5258
Mailing Address - Street 1:305 NORTH THORNTON
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962
Mailing Address - Country:US
Mailing Address - Phone:918-773-5258
Mailing Address - Fax:918-773-5136
Practice Address - Street 1:305 NORTH THORNTON
Practice Address - Street 2:
Practice Address - City:VIAN
Practice Address - State:OK
Practice Address - Zip Code:74962
Practice Address - Country:US
Practice Address - Phone:918-773-5258
Practice Address - Fax:918-773-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH68046804313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375433Medicare ID - Type Unspecified