Eastgate Village LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH5113-5113 Issued in OK

Legal business name

EASTGATE VILLAGE LLC

Practice address

3500 Haskell Blvd
Muskogee, OK 74403-3915

Phone

(918) 682-3191

Fax

(918) 682-1131

NPI assigned

May 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary Louise Fletcher

Title

Administrator

Phone

(918) 682-3191

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1083663512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 HASKELL BLVD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744033915",
            "telephone_number": "918-682-3191",
            "fax_number": "918-682-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 HASKELL BLVD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744033915",
            "telephone_number": "918-682-3191",
            "fax_number": "918-682-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE VILLAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "FLETCHER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "918-682-3191",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH5113-5113",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH5113-5113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Walden Earhart, D.O.
• Jordan Lee Earp, PHARMD
• Kennington Easley
• Eastern Oklahoma Development District
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• Peggy Eaton, MSW, LCSW
• Brittany Laree Ebers, RD/LD
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• Skilled Nursing Facility in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.