NPIMap

Organization Active NPI

Oak Place Living Center, LLC

Doing business as Oak Place

  • Intellectual Disabilities Intermediate Care Facility
  • Wetumka, OK
National Provider Identifier
1114002987
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
NH3213-3213 Issued in OK
Legal business name
OAK PLACE LIVING CENTER, LLC
Doing business as
Oak Place
Practice address
201 E 2ND St
Wetumka, OK 74883-6040
Phone
(405) 452-3271
Fax
(405) 452-5154
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Authorized official

Name
Mrs. Donna R Simmons
Title
Office Manager
Phone
(405) 380-6671

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NH3213-3213 OK Primary

Addresses

Primary practice location

201 E 2ND St
Wetumka, OK 74883-6040

Mailing address

PO Box 488
Weleetka, OK 74880-0488
Phone (405) 786-2266

Other identifiers 1

IdentifierTypeStateIssuer
200104640AMedicaidOK

Other names 1

  • Oak Place Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Maple Place3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1114002987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "city": "WELEETKA",
            "state": "OK",
            "postal_code": "748800488",
            "telephone_number": "405-786-2266",
            "fax_number": "405-786-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E 2ND ST",
            "city": "WETUMKA",
            "state": "OK",
            "postal_code": "748836040",
            "telephone_number": "405-452-3271",
            "fax_number": "405-452-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK PLACE LIVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-380-6671",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OK",
            "license": "NH3213-3213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200104640A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wetumka, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.