Provider Demographics
NPI:1013232800
Name:PF LAWTON SNF OPS, LLC
Entity Type:Organization
Organization Name:PF LAWTON SNF OPS, LLC
Other - Org Name:MONTEVISTA REHABILITATION AND SKILLED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-725-2837
Mailing Address - Street 1:1500 WATERS RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6056
Mailing Address - Country:US
Mailing Address - Phone:214-725-2837
Mailing Address - Fax:469-312-3796
Practice Address - Street 1:7604 NW QUANAH PARKER TRAILWAY
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-1155
Practice Address - Country:US
Practice Address - Phone:580-536-2866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNF 1605314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200309390AMedicaid
OK375540Medicare Oscar/Certification