Provider Demographics
NPI:1710945613
Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC.
Entity Type:Organization
Organization Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC.
Other - Org Name:ENTRUSTED HEARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PLANNING & PROJECT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-3000
Mailing Address - Street 1:3800 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6639
Mailing Address - Country:US
Mailing Address - Phone:405-942-3000
Mailing Address - Fax:405-942-0018
Practice Address - Street 1:9700 MASHBURN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-5509
Practice Address - Country:US
Practice Address - Phone:405-720-2401
Practice Address - Fax:405-720-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7635251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100810750CMedicaid
377619Medicare Oscar/Certification