D E K Management LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH1902-1902 Issued in OK

Legal business name

D E K MANAGEMENT LLC

Practice address

102 E Line Ave
Sapulpa, OK 74066-2858

Phone

(918) 224-0833

Fax

(918) 227-2405

NPI assigned

Jul 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ernest M Johnson III

Title

Administrator/Managing Member

Phone

(918) 224-0833

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NORTHSIDE NURSING HOME Doing business as

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1629001409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10842 S 137TH WEST AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740666737",
            "telephone_number": "918-224-0833",
            "fax_number": "918-227-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E LINE AVE",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740662858",
            "telephone_number": "918-224-0833",
            "fax_number": "918-227-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D E K MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR/MANAGING MEMBER",
        "authorized_official_telephone_number": "918-224-0833",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH1902-1902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200044850A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHSIDE NURSING HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shanika D Crowley
• Jodi Patrice Crutchfield, MS, CCC-SLP
• Aeja Levon Cunningham
• Cura for the World Foundation Pharmacy
• William Cypert
• Benjamin Wayne Dale
• Breanna R Dale, RD,LD
• Mary Davenport, MSW
• Rick Merriman Davenport II
• Richard Summerfield Davidson, LSW

• Nursing Facility/Intermediate Care Facility in Sapulpa, OK
• Providers in Sapulpa, OK by specialty
• Nursing Facility/Intermediate Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.