Provider Demographics
NPI:1184798225
Name:ENID SENIOR CARE LLC
Entity type:Organization
Organization Name:ENID SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-786-2276
Mailing Address - Street 1:410 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3774
Mailing Address - Country:US
Mailing Address - Phone:580-237-1973
Mailing Address - Fax:
Practice Address - Street 1:410 N 30TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3774
Practice Address - Country:US
Practice Address - Phone:580-237-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENID SENIOR CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH 2410-2410314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058950AMedicaid
OK375182Medicare ID - Type Unspecified