Provider Demographics
NPI:1154538502
Name:SUNSET HEALTHCARE, LLC
Entity type:Organization
Organization Name:SUNSET HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP BUSINESS MGR
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:WENDY
Authorized Official - Last Name:MCENTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-0881
Mailing Address - Street 1:1380 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5215
Mailing Address - Country:US
Mailing Address - Phone:405-737-0881
Mailing Address - Fax:405-737-0899
Practice Address - Street 1:2100 TOWNSEND DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2116
Practice Address - Country:US
Practice Address - Phone:405-262-3323
Practice Address - Fax:405-262-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH0904-0904313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20008750AMedicaid
OK20008750AMedicaid