Provider Demographics
NPI:1962780635
Name:N&R OF CHICKASHA, LLC
Entity type:Organization
Organization Name:N&R OF CHICKASHA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-9525
Mailing Address - Street 1:329 TOWNEPARK CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2348
Mailing Address - Country:US
Mailing Address - Phone:502-254-9525
Mailing Address - Fax:502-954-9524
Practice Address - Street 1:2500 S 12TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-6700
Practice Address - Country:US
Practice Address - Phone:405-224-1397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility