Provider Demographics
NPI:1659351641
Name:AMBERWOOD NURSING CENTER
Entity Type:Organization
Organization Name:AMBERWOOD NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENVER
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-616-2144
Mailing Address - Street 1:5900 N ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-7451
Mailing Address - Country:US
Mailing Address - Phone:405-843-5900
Mailing Address - Fax:405-842-0994
Practice Address - Street 1:5900 N ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-7451
Practice Address - Country:US
Practice Address - Phone:405-843-5900
Practice Address - Fax:405-842-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5542-5542313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375248Medicare Oscar/Certification