Provider Demographics
NPI:1518052281
Name:EQUITY FUNDING LLC
Entity Type:Organization
Organization Name:EQUITY FUNDING LLC
Other - Org Name:WILSON NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-668-2337
Mailing Address - Street 1:867 US HIGHWAY 70A
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:OK
Mailing Address - Zip Code:73463-1683
Mailing Address - Country:US
Mailing Address - Phone:580-668-2337
Mailing Address - Fax:580-668-2077
Practice Address - Street 1:867 US HIGHWAY 70A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:OK
Practice Address - Zip Code:73463-1683
Practice Address - Country:US
Practice Address - Phone:580-668-2337
Practice Address - Fax:580-668-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375522Medicare Oscar/Certification