Provider Demographics
NPI:1558754564
Name:MIDWEST CITY HEALTHCARE RESIDENCE OPERATOR LLC
Entity Type:Organization
Organization Name:MIDWEST CITY HEALTHCARE RESIDENCE OPERATOR LLC
Other - Org Name:MIDWEST CITY HEALTHCARE RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-3462
Mailing Address - Street 1:111 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3342
Mailing Address - Country:US
Mailing Address - Phone:214-396-3462
Mailing Address - Fax:
Practice Address - Street 1:8200 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-8518
Practice Address - Country:US
Practice Address - Phone:405-737-8200
Practice Address - Fax:405-622-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility