Provider Demographics
NPI:1265542617
Name:SEQUOYAH EAST NURSING CENTER LLC
Entity type:Organization
Organization Name:SEQUOYAH EAST NURSING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIGIACINTO
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:918-427-7401
Mailing Address - Street 1:701 S TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954
Mailing Address - Country:US
Mailing Address - Phone:918-427-7401
Mailing Address - Fax:918-427-6629
Practice Address - Street 1:701 S TAYLOR RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954
Practice Address - Country:US
Practice Address - Phone:918-427-7401
Practice Address - Fax:918-427-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH68026802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375394Medicare ID - Type Unspecified