Provider Demographics
NPI:1861960940
Name:MEMORY CARE CENTER AT EMERALD, LLC
Entity type:Organization
Organization Name:MEMORY CARE CENTER AT EMERALD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-399-3051
Mailing Address - Street 1:2700 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-1214
Mailing Address - Country:US
Mailing Address - Phone:918-341-4365
Mailing Address - Fax:516-504-9817
Practice Address - Street 1:2700 HICKORY ST
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-1214
Practice Address - Country:US
Practice Address - Phone:918-283-4949
Practice Address - Fax:918-283-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility