Provider Demographics
NPI:1538661905
Name:SENIOR VILLAGE OPERATIONS LLC
Entity Type:Organization
Organization Name:SENIOR VILLAGE OPERATIONS LLC
Other - Org Name:SENIOR VILLAGE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-1144
Mailing Address - Street 1:4350 WILL ROGERS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1839
Mailing Address - Country:US
Mailing Address - Phone:405-943-1144
Mailing Address - Fax:405-639-2742
Practice Address - Street 1:1104 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-6504
Practice Address - Country:US
Practice Address - Phone:405-485-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200754620AMedicaid