Provider Demographics
NPI:1588872428
Name:HERITAGE ASSISTED LIVING CENTER L.L.C.
Entity type:Organization
Organization Name:HERITAGE ASSISTED LIVING CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-722-5552
Mailing Address - Street 1:9025 NW EXPRESSWAY ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8374
Mailing Address - Country:US
Mailing Address - Phone:405-722-5552
Mailing Address - Fax:405-722-8862
Practice Address - Street 1:9025 NW EXPRESSWAY ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8374
Practice Address - Country:US
Practice Address - Phone:405-722-5552
Practice Address - Fax:405-722-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKAL0905-0905OtherASSISTED LIVING