Fair Oaks Residential Care LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

RC4902-4902 Issued in OK

Legal business name

FAIR OAKS RESIDENTIAL CARE LLC

Practice address

1330 N 3Rd St
Langley, OK 74350

Phone

(918) 782-3180

Fax

(918) 782-9715

NPI assigned

Apr 4, 2007

Last updated

Aug 22, 2020By 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

Denise Wilson, LPNNPI 1659493559

Title

Administrator

Phone

(918) 260-5422

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Denise Wilson, LPN

  • Licensed Practical Nurse
  • Langley, OK
  • NPI 1659493559
  NPD (past) Authorized official

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801918784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 475",
            "city": "LANGLEY",
            "state": "OK",
            "postal_code": "743500475",
            "telephone_number": "918-782-3180",
            "fax_number": "918-782-9175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 N 3RD ST",
            "city": "LANGLEY",
            "state": "OK",
            "postal_code": "74350",
            "telephone_number": "918-782-3180",
            "fax_number": "918-782-9715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR OAKS RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "918-260-5422",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "OK",
            "license": "RC4902-4902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Langley, OK
• Providers in Langley, OK by specialty
• Assisted Living Facility (Mental Illness) 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.