Basic Information
| Provider Information | |||||||||
| NPI: | 1508103508 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ER NURSING, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EDWARDS REDEEMER NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 NE GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731175212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054242273 | ||||||||
| FaxNumber: | 4054242070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 NE GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731175212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054242273 | ||||||||
| FaxNumber: | 4054242070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2013 | ||||||||
| LastUpdateDate: | 01/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | GENTRY | ||||||||
| AuthorizedOfficialFirstName: | BOYD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 6788695116 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH5549-5549 | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.