Watermark Canterbury, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WATERMARK CANTERBURY, LLC

Doing business as

The Fountains at Canterbury

Practice address

1404 NW 122ND St
Oklahoma City, OK 73114-8000

Phone

(405) 751-3600

Fax

(405) 751-6511

NPI assigned

May 11, 2015

Organization subpart

No

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

Authorized official

Name

Greta Frazier

Title

Director

Phone

(520) 797-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Fountains at Canterbury Doing business as

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507766400000",
    "number": "1740668847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 W RUDASILL RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857047800",
            "telephone_number": "520-797-4000",
            "fax_number": "520-797-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 NW 122ND ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731148000",
            "telephone_number": "405-751-3600",
            "fax_number": "405-751-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERMARK CANTERBURY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2017-10-12",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "GRETA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "520-797-4000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE DEPARTMENT OF HEALTH",
            "identifier": "CC5503-5503",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Fountains at Canterbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emma Wassilak, M.ED., LPC
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• Skilled Nursing Facility in Oklahoma City, OK
• Providers in Oklahoma City, 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 Oct 12, 2017; 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.