Edna Lee'S Residential Care

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

RC1806-1806 Issued in OK

Legal business name

EDNA LEE'S RESIDENTIAL CARE

Practice address

421 W South Ave
Vinita, OK 74301-4143

Phone

(918) 256-3131

NPI assigned

May 9, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Donna J KelleyNPI 1336423052

Title

Administrator

Phone

(918) 256-3131

Specialties & licenses 1

Addresses

Tax ID family

Edna Lee'S Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Edna Lee'S, Inc.

  • Assisted Living Facility
  • Vinita, OK
  • NPI 1023346574
  NPD tax ID

Locations

Practitioners 2

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

• Donna Kelley

  • Case Manager/Care Coordinator
  • Vinita, OK
  • NPI 1336423052
  NPD (past) Authorized official
• Carlissia Kelley

  • Case Manager/Care Coordinator
  • Vinita, OK
  • NPI 1730917642
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508070830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 W SOUTH AVE",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "743014143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 W SOUTH AVE",
            "city": "VINITA",
            "state": "OK",
            "postal_code": "743014143",
            "telephone_number": "918-256-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDNA LEE'S RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "918-256-3131",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "RC1806-1806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Kristann Douthit, PTA
• Andrea Downing
• Dr.Mickey Tyrrell, M.D. PLLC
• Morgan Drosche
• Shalaina Dunn, MA, LPC
• Edna Lee'S, Inc.
• Leslie Elms-Nair, M.S., LPC
• Randi Elrod
• Brittany Renee English, PHARM D.
• Lynnae Englund

• All providers in Vinita, OK
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.