Provider Demographics
NPI:1750124855
Name:CHANDLER NURSING AND REHAB LLC
Entity type:Organization
Organization Name:CHANDLER NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-236-9507
Mailing Address - Street 1:444991 EAST LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:GORE
Mailing Address - State:OK
Mailing Address - Zip Code:74435
Mailing Address - Country:US
Mailing Address - Phone:479-236-9507
Mailing Address - Fax:
Practice Address - Street 1:601 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2441
Practice Address - Country:US
Practice Address - Phone:405-258-1131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility