Provider Demographics
NPI:1902054059
Name:BRYANT HEALTHCARE LLC
Entity Type:Organization
Organization Name:BRYANT HEALTHCARE LLC
Other - Org Name:CARE LIVING CENTER OF EDMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:NARULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-2106
Mailing Address - Street 1:1380 S DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5215
Mailing Address - Country:US
Mailing Address - Phone:405-737-2106
Mailing Address - Fax:405-737-0899
Practice Address - Street 1:1100 E 9TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5705
Practice Address - Country:US
Practice Address - Phone:405-341-5617
Practice Address - Fax:405-341-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility