Provider Demographics
NPI:1790473502
Name:COMMUNITY NURSING CENTER OF OKLAHOMA CITY, LLC
Entity Type:Organization
Organization Name:COMMUNITY NURSING CENTER OF OKLAHOMA CITY, LLC
Other - Org Name:DIVERSITY FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-407-7661
Mailing Address - Street 1:1211 N SHARTEL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2425
Mailing Address - Country:US
Mailing Address - Phone:405-848-0026
Mailing Address - Fax:405-497-6789
Practice Address - Street 1:329 WHITE ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5748
Practice Address - Country:US
Practice Address - Phone:405-848-0026
Practice Address - Fax:405-497-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service