Provider Demographics
NPI:1891110797
Name:ROBERTSON HEALTH CARE LLC
Entity Type:Organization
Organization Name:ROBERTSON HEALTH CARE LLC
Other - Org Name:SERVANT LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-395-2105
Mailing Address - Street 1:616 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73759-1714
Mailing Address - Country:US
Mailing Address - Phone:580-395-2105
Mailing Address - Fax:580-395-2070
Practice Address - Street 1:616 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OK
Practice Address - Zip Code:73759-1714
Practice Address - Country:US
Practice Address - Phone:580-395-2105
Practice Address - Fax:580-395-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH2702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375352Medicare Oscar/Certification