Grand Lake Villa

LBN: Oak Lake, Llc
Grand Lake Villa is an health care organization with primary practice located at 103 Har-Ber Rd , Grove OK 74345-0547. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Oak Lake, Llc can be contacted via phone (918) 786-2276, or through Brogdon, Chris via phone (770) 650-8793.

Contact Information

Primary practice address
103 Har-Ber Rd Grove OK 74345-0547
Phone: (918) 786-2276
Fax: (918) 786-4526
Website:
Map and Directions
Authorized official contact:
Name: Brogdon, Chris
Phone: (770) 650-8793

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X

Profile Details

NPI number 1154628790
LBN Legal business name Oak Lake, Llc
DBA Doing business as Grand Lake Villa
Authorized official Brogdon, Chris
Entity Organization
Organization subpart 1 No
Enumeration date Feb 17th, 2011
Last updated Jan 19th, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154628790 NPPES
Oklahoma MEDICAID 20059540A

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