Basic Information
| Provider Information | |||||||||
| NPI: | 1033310370 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NARULAS HEALTHCARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MUSTANG MANOR ASSISTED LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 S DOUGLAS BLVD | ||||||||
| Address2: | |||||||||
| City: | MIDWEST CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731305215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057370881 | ||||||||
| FaxNumber: | 4057370899 | ||||||||
| Practice Location | |||||||||
| Address1: | 1017 W HIGHWAY 152 | ||||||||
| Address2: | |||||||||
| City: | MUSTANG | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053765600 | ||||||||
| FaxNumber: | 4053763867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCENTIRE | ||||||||
| AuthorizedOfficialFirstName: | S | ||||||||
| AuthorizedOfficialMiddleName: | WENDY | ||||||||
| AuthorizedOfficialTitleorPosition: | CORP BUSINESS MGR | ||||||||
| AuthorizedOfficialTelephone: | 4057370881 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL0902-0902 | OK | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.