Provider Demographics
NPI:1780720045
Name:RELIANT LIVING CENTERS OF OKLAHOMA
Entity type:Organization
Organization Name:RELIANT LIVING CENTERS OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATROR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:JERNIGNA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:405-677-0502
Mailing Address - Street 1:2901 SE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-8413
Mailing Address - Country:US
Mailing Address - Phone:405-677-2421
Mailing Address - Fax:405-677-4276
Practice Address - Street 1:2901 SE 22ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-8413
Practice Address - Country:US
Practice Address - Phone:405-677-2421
Practice Address - Fax:405-677-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5537313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility