Provider Demographics
NPI:1316934672
Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC.
Entity type:Organization
Organization Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PLANNING & PROJECT MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-3800
Mailing Address - Street 1:12600 E 73RD ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4017
Mailing Address - Country:US
Mailing Address - Phone:918-272-2281
Mailing Address - Fax:918-272-7520
Practice Address - Street 1:12600 E 73RD ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4017
Practice Address - Country:US
Practice Address - Phone:918-272-2281
Practice Address - Fax:918-272-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCC7206-7206314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100810750BMedicaid
OK100810750BMedicaid