Provider Demographics
NPI:1831332824
Name:LEGEND AT COUNCIL ROAD
Entity type:Organization
Organization Name:LEGEND AT COUNCIL ROAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-721-0300
Mailing Address - Street 1:11320 N COUNCIL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2517
Mailing Address - Country:US
Mailing Address - Phone:405-721-0300
Mailing Address - Fax:
Practice Address - Street 1:11320 N COUNCIL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2517
Practice Address - Country:US
Practice Address - Phone:405-721-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care