Basic Information
| Provider Information | |||||||||
| NPI: | 1538416656 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CSCC NURSING, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPANIONS SPECIALIZED CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 E 36TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741355810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186223430 | ||||||||
| FaxNumber: | 9186220626 | ||||||||
| Practice Location | |||||||||
| Address1: | 6201 E 36TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741355810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186223430 | ||||||||
| FaxNumber: | 9186220626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2012 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | GENTRY | ||||||||
| AuthorizedOfficialFirstName: | BOYD | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 6788695118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.