Provider Demographics
NPI:1265742092
Name:PARCWAY
Entity type:Organization
Organization Name:PARCWAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICATION AIDE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIKAODI
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-946-6932
Mailing Address - Street 1:6312 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-946-6932
Mailing Address - Fax:
Practice Address - Street 1:6312 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1463
Practice Address - Country:US
Practice Address - Phone:405-946-6932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V6650107073140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric