Provider Demographics
NPI:1891728820
Name:NURSING CENTER OF THE SOUTHWEST LLC
Entity Type:Organization
Organization Name:NURSING CENTER OF THE SOUTHWEST LLC
Other - Org Name:PLANTATION VILLAGE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:B.
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BRINKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-480-1800
Mailing Address - Street 1:2610 CEDAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1312
Mailing Address - Country:US
Mailing Address - Phone:580-480-1800
Mailing Address - Fax:580-477-2006
Practice Address - Street 1:2610 CEDAR CREEK DR
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1312
Practice Address - Country:US
Practice Address - Phone:580-480-1800
Practice Address - Fax:580-477-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH3305-3305313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility