Provider Demographics
NPI:1467759951
Name:SENIOR NH, LLC
Entity type:Organization
Organization Name:SENIOR NH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-650-8793
Mailing Address - Street 1:410 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3774
Mailing Address - Country:US
Mailing Address - Phone:580-237-1973
Mailing Address - Fax:580-237-0755
Practice Address - Street 1:410 N 30TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3774
Practice Address - Country:US
Practice Address - Phone:580-237-1973
Practice Address - Fax:580-237-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058950AMedicaid
375182Medicare Oscar/Certification