Provider Demographics
NPI:1700267754
Name:SOUTHWEST LTC - NW OKC, LLC
Entity Type:Organization
Organization Name:SOUTHWEST LTC - NW OKC, LLC
Other - Org Name:NORTHWEST NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:469-916-6100
Mailing Address - Street 1:1518 LEGACY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6038
Mailing Address - Country:US
Mailing Address - Phone:469-916-6100
Mailing Address - Fax:469-916-6105
Practice Address - Street 1:2801 NW 61ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7007
Practice Address - Country:US
Practice Address - Phone:405-842-6601
Practice Address - Fax:405-810-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375520Medicare Oscar/Certification