Provider Demographics
NPI:1669985305
Name:CLINTON THERAPY & LIVING CENTER, LLC
Entity type:Organization
Organization Name:CLINTON THERAPY & LIVING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-769-5535
Mailing Address - Street 1:2316 W MODELLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3722
Mailing Address - Country:US
Mailing Address - Phone:580-323-0912
Mailing Address - Fax:580-323-4935
Practice Address - Street 1:2316 W MODELLE AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3722
Practice Address - Country:US
Practice Address - Phone:580-323-0912
Practice Address - Fax:580-323-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility