Lightning Creek Investment Group Inc

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH7702-7702 Issued in OK

Legal business name

LIGHTNING CREEK INVESTMENT GROUP INC

Practice address

402 SE 6TH St
Mooreland, OK 73852-9064

Phone

(918) 273-3649

Fax

(918) 273-5652

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Douglas G. Maddux

Title

President

Phone

(918) 273-3649

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MOORELAND HERITAGE MANOR Doing business as

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279584000000",
    "number": "1346385689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468",
            "city": "NOWATA",
            "state": "OK",
            "postal_code": "740480468",
            "telephone_number": "918-273-3649",
            "fax_number": "918-273-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 SE 6TH ST",
            "city": "MOORELAND",
            "state": "OK",
            "postal_code": "738529064",
            "telephone_number": "918-273-3649",
            "fax_number": "918-273-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTNING CREEK INVESTMENT GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2010-07-20",
        "status": "A",
        "authorized_official_last_name": "MADDUX",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-273-3649",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH7702-7702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776120B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOORELAND HERITAGE MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Mooreland, OK
• Nursing Facility/Intermediate Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; 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.