Basic Information
| Provider Information | |||||||||
| NPI: | 1013232800 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PF LAWTON SNF OPS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONTEVISTA REHABILITATION AND SKILLED CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 WATERS RIDGE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750576056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147252837 | ||||||||
| FaxNumber: | 4693123796 | ||||||||
| Practice Location | |||||||||
| Address1: | 7604 NW QUANAH PARKER TRAILWAY | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735051155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805362866 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHANCE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 2147252837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NF 1605 | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.