Provider Demographics
NPI:1154589430
Name:STATE OF OKLAHOMA
Entity type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERMIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-523-4007
Mailing Address - Street 1:10014 SE 1138TH STREET
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-6028
Mailing Address - Country:US
Mailing Address - Phone:918-567-2251
Mailing Address - Fax:918-567-2251
Practice Address - Street 1:10014 SE 1138TH STREET
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-6028
Practice Address - Country:US
Practice Address - Phone:918-567-2251
Practice Address - Fax:918-567-2251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA DEPT OF VETERANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-23
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKWVC2007006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility