Grand Lake Villa LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH 2102-2102 Issued in OK

Legal business name

GRAND LAKE VILLA LLC

Practice address

103 W 13TH St
Grove, OK 74344-3224

Phone

(918) 786-2276

NPI assigned

Nov 20, 2006

Last updated

Sep 16, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Micheline Nader

Title

Owner

Phone

(918) 786-2276

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316131200000",
    "number": "1740354893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W 13TH ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743443224",
            "telephone_number": "918-786-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W 13TH ST",
            "city": "GROVE",
            "state": "OK",
            "postal_code": "743443224",
            "telephone_number": "918-786-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LAKE VILLA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2011-09-16",
        "status": "A",
        "authorized_official_last_name": "NADER",
        "authorized_official_first_name": "MICHELINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-786-2276"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH 2102-2102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200059540A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Grand Lake Optical, LLC
• Grand Lake Regional Cardiology Services LLC
• Grand Lake Therapeutics LLC
• Grandwood Assisted Living, LC
• Christopher Gray, NP
• Sarah Green, MSW
• Joseph Gregory, APRN
• Carol Penelope Griffith, CMII, PRSS

• Skilled Nursing Facility in Grove, OK
• Providers in Grove, 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 16, 2011; 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.